Left ventricular pseudoaneurysm rupture following prosthesis infective endocarditis after closure of ventricular septal rupture

BACKGROUND: Left ventricular pseudoaneurysm (LVP) is a rare but life-threatening complication of myocardial infarction or cardiac surgery, typically arising within the first few years after ventricular septal rupture (VSR) repair. Delayed rupture associated with prosthetic infection is extremely uncommon and carries high mortality. CASE PRESENTATION: We report the case of a 47-year-old man with a history of post-infarction VSR repair using the infarct exclusion technique. The patient remained stable for nearly nine years before undergoing transcatheter closure of a residual VSR with an Amplatzer occluder. Within a year, he presented with septic shock following recurrent urosepsis and bacteremia. Imaging revealed a large LVP (9.8 × 5.1 cm) with rupture at the prior ventriculotomy site, accompanied by vegetations on both the surgical patch and occluder. Emergent redo surgery was performed, requiring radical debridement, explantation of all prosthetic material, and two-patch reconstruction with bovine pericardium. The postoperative course was complicated by serial multidrug-resistant infections and Candida albicans fungemia, followed by drug rash with eosinophilia and systemic symptoms (DRESS syndrome) secondary to amphotericin B. With tailored antimicrobial therapy, vital organ support, and multidisciplinary care, the patient gradually recovered and was discharged on postoperative day 84. CONCLUSIONS: This case highlights the potential for extremely delayed pseudoaneurysm rupture after VSR repair, triggered by prosthetic infective endocarditis. Successful management required aggressive surgical debridement, complete prosthetic explantation, innovative reconstruction, and meticulous postoperative infection control. Long-term vigilance is essential in patients with residual VSR and prosthetic material.