Pseudoaneurysm of the left ventricle with moderate left-to-right shunt

A 79 year old man was admitted to the hospital with increased breathlessness and fatigue on minimal exertion, and this since a few weeks. Transthoracic and transesophageal echocardiography, followed by cardiovascular magnetic resonance imaging, demonstrated a cardiac pseudoaneurysm connected with both ventricular cavities resulting in an extracardiac left-to-right shunt, with even re-perforating into the right atrium. These findings were suggested to be sequels from an inferior myocardial infarction. Given the age and the complex characteristics of the aneurysm, conservative management was the treatment of choice. At one year follow-up the patient was still doing well.