Left Ventricular Pseudoaneurysm After Sutureless Repair for Post-Myocardial Infarction Oozing-Type Left Ventricular Free Wall Rupture

A 66-year-old male patient underwent repair using the sutureless technique for an oozing-type cardiac rupture associated with myocardial infarction of the anterior left ventricular wall. On postoperative day 10, echocardiography revealed a thrombus in the apex region, and anticoagulation therapy was started with warfarin. The thrombus disappeared two months postoperatively. Four months after surgery, the patient came to the hospital with a chief complaint of breathlessness. The computer tomography scan showed a pseudoaneurysm in the left ventricular anterior wall. Because of breathlessness due to decreased effective cardiac output associated with the left ventricular mass and the risk of rupture of the left ventricular pseudoaneurysm, we decided that surgery was indicated. When the left ventricular pseudoaneurysm was incised under cardiac arrest using an artificial heart-lung machine, an oval-shaped communication orifice was found, which was closed directly with continuous sutures. The breathlessness disappeared and the patient was discharged 13 days after surgery.