A giant left ventricular pseudoaneurysm like an "hourglass" after silent myocardial infarction.

A 51-year-old man was referred to our institution for dyspnea on exertion and non-productive cough, of three-month history. A silent inferior myocardial infarction was detected incidentally on an ECG that manifested itself as inferior Q waves. Two-dimensional transthoracic echocardiography demonstrated a second large cardiac chamber (6x5 cm) adjacent to the inferior-basal left ventricle wall, with a narrow neck and to-and-fro signals during Doppler US evaluation. Ventriculography showed a pseudoaneurysm, like an hourglass, on the inferior wall of the left ventricle which was approximately 6x5 cm in diameter. Coronary angiography showed triple vessel disease with total occlusion of the circumflex coronary artery. These findings were consistent with left ventricular pseudoaneurysm resulting from an old inferior myocardial infarction. After diagnosis of left ventricular pseudoaneurysm and concomitant coronary artery disease, surgery was recommended. He underwent coronary artery bypass surgery including the repair of the pseudoaneurysm. But, unfortunately the patient died in during the operation. This case illustrates that pseudoaneurysm can develop after silent myocardial infarction with nonspecific symptoms. In addition, if false aneurysm invades adjacent organs such as lungs, then the risk of surgical mortality increases. [ABSTRACT FROM AUTHOR]