Case Report on Anaesthetic Techniques for Minimally Invasive Closure of Left Ventricular Pseudoaneurysm

Background Left ventricular pseudoaneurysm (LVPSA) is a rare but life-threatening complication of transmural myocardial infarction, associated with a high risk of rupture and mortality. While surgical repair remains the gold standard, percutaneous closure is emerging as a viable option in high-risk patients.  Objective To describe the anaesthetic management and clinical outcomes of a high-risk patient undergoing percutaneous closure of an LV pseudoaneurysm.  Methods We report the case of a 63-year-old male with New York Heart Association (NYHA) class IV symptoms, prior mechanical aortic valve replacement, hypertension, and frailty, who presented with chest pain and dyspnoea. Imaging revealed a 30×17 mm LV pseudoaneurysm with a 10 mm neck. Percutaneous device closure was planned under general anaesthesia with transoesophageal echocardiography (TEE) guidance. Standard ASA monitoring, entropy, and neuromuscular transmission monitoring were used. Haemodynamic stability was maintained with titrated anaesthetic drugs and a low-dose vasopressor infusion.  Results The procedure was successfully completed with deployment of an Amplatzer device under combined TEE and fluoroscopic guidance. Post-procedural elevated left ventricular end-diastolic pressure was managed with diuretics. Extubation was delayed to optimize recovery and performed six hours post-procedure. The patient had an uneventful recovery and was discharged on the fourth postoperative day.  Conclusion This case highlights that percutaneous LVPSA closure under general anaesthesia with real-time imaging is a feasible and safe alternative in select high-risk patients. Careful haemodynamic optimization and anaesthetic planning are crucial to avoid aneurysm rupture and to ensure favourable outcomes.