Biventricular pseudoaneurysm with secondary left-to-right shunting as a rare complication of myocardial infarction

Biventricular pseudoaneurysm with secondary left-to-right shunting as a rare complication of myocardial infarction | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 3 October 2025 V1 Latest version Share on Biventricular pseudoaneurysm with secondary left-to-right shunting as a rare complication of myocardial infarction Authors : Haoyu Lu 0009-0007-9176-3810 , Ding Zhang , HuaYing Fu 0000-0002-5497-4674 , Tienan Chen , Feixue Li , Tong Liu 0000-0003-0482-0738 , and Changle Liu [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.175952162.28413569/v1 127 views 96 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Biventricular pseudoaneurysm is an infrequent complication following myocardial infarction. The diagnosis is complex and has a high risk of rupture. Transthoracic echocardiogram (TTE) and Cardiac magnetic resonance (CMR) are crucial for diagnosing. We present the case of a 79-year-old man who experienced PCI for AMI. Subsequent TTE revealed an apical pseudoaneurysm. To confirm the diagnosis and observe the progression, follow-up TTE and CMR were performed, confirming the pseudoaneurysm involved both ventricles with secondary left-to-right shunting. Surgical repair was performed, with postoperative TTE demonstrating the complete resolution of shunts. Biventricular pseudoaneurysm with secondary left-to-right shunting as a rare complication of myocardial infarction Haoyu Lu 1 , Ding Zhang 1 , Huaying Fu 1 , Tienan Chen 1 , Feixue Li 1 , Tong Liu 1 , Changle Liu 2* 1. The Second Hospital of Tianjin Medical University 2. The Second Hospital of Tianjin Medical University, Electronic address: [email protected] Haoyu Lu: The Second Hospital of Tianjin Medical University, [email protected] Ding Zhang: The Second Hospital of Tianjin Medical University, [email protected] Huaying Fu: The Second Hospital of Tianjin Medical University, [email protected] Tienan Chen: The Second Hospital of Tianjin Medical University, [email protected] Feixue Li: The Second Hospital of Tianjin Medical University, [email protected] Tong Liu: The Second Hospital of Tianjin Medical University, [email protected] Changle Liu: The Second Hospital of Tianjin Medical University, [email protected] Abstract Biventricular pseudoaneurysm is an infrequent complication following myocardial infarction. The diagnosis is complex and has a high risk of rupture. Transthoracic echocardiogram (TTE) and Cardiac magnetic resonance (CMR) are crucial for diagnosing. We present the case of a 79-year-old man who experienced PCI for AMI. Subsequent TTE revealed an apical pseudoaneurysm. To confirm the diagnosis and observe the progression, follow-up TTE and CMR were performed, confirming the pseudoaneurysm involved both ventricles with secondary left-to-right shunting. Surgical repair was performed, with postoperative TTE demonstrating the complete resolution of shunts. Keywords : Echocardiography, ventricular pseudoaneurysm, cardiovascular surgery, mechanical complications of acute myocardial infarction Description A 79-year-old man experienced emergency PCI for AMI. On hospital day 3, a Grade IV holosystolic murmur was auscultated between the third and fourth ribs near the sternum. TTE identified apical dyskinesia and an apical pseudoaneurysm (5.9cm*2.5cm) originating from the left ventricular apex (Fig.1A). TTE revealed fenestrated communications (2.1cm in length) between the pseudoaneurysm and right ventricular (Fig.1B), with communication between the pseudoaneurysm and both ventricles (Fig.1C-D). On hospital day 8, the repeat TTE demonstrated a left-to-right ventricular shunt (Fig.2A-B), pseudoaneurysm recurrence (diameter 2.19cm long; Fig.2C), and retrograde intramyocardial dissection (0.69cm in length) with swinging motion of the dissected ventricular septum (Fig.2D). CMR shows a lack of epicardial fat near the pseudoaneurysm and a blurred pericardial line (Fig.3). Surgical repair was performed, with postoperative TTE demonstrating the complete resolution of shunts. Pseudoaneurysm usually occurs in the basal two-thirds of the left ventricular [1]. However, this case reveals an extremely rare biventricular pseudoaneurysm whose rupture area is in the less common apical region, with its progression process by TTE, and timely surgery intervention is needed [2]. 1. Lewis AJ, Burchell HB, Titus JL. Clinical and pathologic features of postinfarction cardiac rupture. Am J Cardiol . 1969;23(1):43-53. doi:10.1016/0002-9149(69)90240-9 2. Prêtre R, Linka A, Jenni R, Turina MI. Surgical treatment of acquired left ventricular pseudoaneurysms. Ann Thorac Surg . 2000;70(2):553-557. doi:10.1016/s0003-4975(00)01412-0 Fig.1 A apical dyskinesia and an apical pseudoaneurysm (5.9cm*2.5cm) originating from the left ventricular apex. B fenestrated communications (2.1cm in length) between the pseudoaneurysm and the right ventricular. C and D blood flows into the pseudoaneurysm from both ventricular sides. Fig.2 A and B: a left-to-right ventricular shunt. C pseudoaneurysm recurrence (diameter 2.19cm long). D retrograde intramyocardial dissection (0.69cm in length) with swinging motion of the dissected ventricular septum. Fig.3 Cardiac-MRI demonstrated the pseudoaneurysm. Information & Authors Information Version history V1 Version 1 03 October 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords cardiovascular surgery echocardiography mechanical complications of acute myocardial infarction ventricular pseudoaneurysm Authors Affiliations Haoyu Lu 0009-0007-9176-3810 The Second Hospital of Tianjin Medical University View all articles by this author Ding Zhang The Second Hospital of Tianjin Medical University View all articles by this author HuaYing Fu 0000-0002-5497-4674 The Second Hospital of Tianjin Medical University View all articles by this author Tienan Chen The Second Hospital of Tianjin Medical University View all articles by this author Feixue Li The Second Hospital of Tianjin Medical University View all articles by this author Tong Liu 0000-0003-0482-0738 The Second Hospital of Tianjin Medical University View all articles by this author Changle Liu [email protected] The Second Hospital of Tianjin Medical University View all articles by this author Metrics & Citations Metrics Article Usage 127 views 96 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Haoyu Lu, Ding Zhang, HuaYing Fu, et al. Biventricular pseudoaneurysm with secondary left-to-right shunting as a rare complication of myocardial infarction. Authorea . 03 October 2025. DOI: https://doi.org/10.22541/au.175952162.28413569/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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