Percutaneous Closure of a Left Ventricular Pseudoaneurysm With Endovascular Coil Embolization: A Case Report

Left ventricular pseudoaneurysm is a rare but potentially life-threatening complication following myocardial infarction. Although the management is usually surgical, percutaneous closure using occluder devices or coil embolization has proven to be a promising, minimally invasive alternative in high-risk cases. We describe a 77-year-old female who presented three weeks after an anterior myocardial infarction with new-onset decompensated heart failure. Multimodality imaging, including echocardiography, left ventriculogram, and contrast-enhanced computed tomography thorax, revealed a basal left ventricular pseudoaneurysm with an approximately 2 mm neck, located in proximity to the aortic root and left anterior descending artery. Given her advanced age, decompensated heart failure, and multiple comorbidities, she was deemed high surgical risk, and percutaneous coil embolization was planned. Despite the anatomically challenging location, successful closure was achieved using four endovascular coils (Axium Prime - Medtronic, Irvine, CA, USA and MicroPlex - MicroVention, Inc., Aliso Viejo, CA, USA), with complete closure confirmed on post-procedure imaging. At two-week follow-up, the patient remained clinically stable, with improvement in symptoms. This case illustrates that coil embolization can be a feasible option in selected high-risk patients with complex anatomy. It also highlights the importance of multimodality imaging, heart team discussions, and extensive pre-procedural planning in achieving successful outcomes.