A 57 year-old man with a history of mitral valve replacement 12 years before was admitted for prolonged palpitations and congestive heart failure. Electrocardiogram showed sustained ventricular tachycardia. After cardioversion, despite the poor acoustic window, echocardiography showed a huge left paraventricular chamber (6 cm length) with a large neck (5 cm width), involving the basal segments of the lateral, posterior and inferior walls, associated with mitral prosthesis rocking (Fig. 1 and Video I). Left ventricle (LV) function was severely depressed. Cardiac magnetic resonance confirmed the presence of a multilobar pseudoaneurysm (8 cm × 6 cm) with a wide neck (6.5 cm), involving the basal inferior and inferolateral segments, with pericardial late enhancement (Fig. 2). Lateral insertion of the mitral prosthesis was supported only by the false aneurysm (Video II). Cardiac computed tomography showed diffuse parietal calcifications in the pseudoaneurysm as well as a large mural thrombus (Fig. 2). The patient was proposed for heart transplantation which occurred a few months later (Fig. 2). Histological analysis of the explanted heart confirmed the diagnosis by revealing the absence of myocardial cells in the wall of the chamber.
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Published online: September 23, 2013
Accepted: August 26, 2013
Received: August 8, 2013
© 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.