A simplified approach to managing a complex infected left ventricular pseudoaneurysm

Background: Left ventricular pseudoaneurysm (LVP) is a rare but life-threatening condition resulting from acute myocardial infarction, trauma, bacterial infection, or previous cardiac operations. Diagnosis can be challenging as LVPs remain asymptomatic or present with nonspecific clinical symptoms. Early diagnosis is crucial to prevent rupture and recurrent septicemia. Various imaging techniques can aid in diagnosis, including transthoracic echocardiography (TTE), transesophageal echocardiography, computed tomography angiography, and cardiac magnetic resonance imaging.

Case report: A 72-year-old man with a history of coronary artery bypass grafting presented with episodes of recurrent fever. An infected LVP was diagnosed using TTE and thoracic Computed tomography (CT) angiography. The patient underwent removal of the infected hematoma with excision and repair of the pseudoaneurysm via left anterior thoracotomy with peripheral cannulation. The neck of the pseudoaneurysm was repaired with a Dacron patch. Post-operative TTE showed no residual pseudoaneurysm tissue, and the patient recovered well.

Conclusion: Our experience with the anterior thoracotomy approach with peripheral cannulation in specific cases of infected LVPs has yielded promising results. However, it is crucial to recognize that this approach may not be universally suitable.