A case of acute myocardial infarction complicated with left ventricular pseudoaneurysm and ventricular septal rupture

: An 87-year-old woman was admitted to another hospital with acute inferior myocardial infarction on May 31, 1991. On the 6th hospital day she suddenly developed transient complete A-V block and ventricular tachycardia. She was transferred to our hospital for the treatment of intractable heart failure on the 18th hospital day. Two-dimensional echocardiography showed a saccular chamber with a narrow-necked connection to the left ventricle. Color Doppler echocardiography showed bidirectional blood flow between the left ventricle and saccular chamber during systole and diastole. There was 35% left to right shunt in the ventricular level on right heart catheterization. Acute myocardial infarction complicated with left ventricular pseudoaneurysm and ventricular septal perforation was diagnosed. She died on the 26th hospital day without aggressive medical treatment. Autopsy demonstrated the pseudoaneurysm in the posterior wall of the left ventricle and the connection to the right ventricle. The so-called double rupture could be diagnosed before death.