Asymptomatic incomplete left ventricular apical rupture diagnosed by cardiac magnetic resonance imaging.
1553-8389/08/$ – see doi:10.1016/j.carrev.2 A 66-year-old man presented with dyspnea for 1 month. He had undergone percutaneous coronary intervention to the left anterior descending and circumflex coronary arteries 4 weeks ago. Three days after the procedure, the echocardiogram showed myocardial free wall rupture and relatively small pseudoaneurysm formation at the posterior base of the heart. Surgical treatment was considered initially; however, the repair attempt was unsuccessful. Since then the dyspnea has worsened. The echocardiogram showed significant expansion of the pseudoaneurysm measuring 13×10 cm (Fig. 1 and supplementary data). Left ventriculography confirmed the presence of a large pseudoaneurysm which was three times the size of the left ventricle (supplementary data). Given the risk of rupture, surgical repair was scheduled again. The pseudoaneurysm was surgically repaired with a patch this time, but the patient expired during the early postoperative period. After incomplete rupture of the heart, the pericardium seals the area along with the organizing thrombus and hematoma. Over time, pseudoaneurysm can originate from this area of rupture. Pseudoaneurysms are characterized by a small and narrow neck that connects the ventricle with the aneurysmal sac. In contrast to true aneurysm, the wall of the pseudoaneurysm has no myocardial elements