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A 66 year old man was readmitted to our hospital because of chest pain on effort. Coronary angiography showed restenosis of the left anterior descending artery, and repeat angioplasty was successful.
One year earlier, the patient was admitted at emergency with severe chest pain. On admission, he had a pulse of 145 beats/min, and a blood pressure of 60 mm Hg with peripheral cyanosis. The ECG showed sinus tachycardia, with ST segment elevation in I, aVL, and V1–6. Transthoracic echocardiography showed left ventricular anterior wall akinesia and a large pericardial effusion with right ventricular collapse. Subsequent coronary angiography revealed triple vessel disease with total occlusion of the left anterior descending artery. Emergency surgery was performed. The pericardial cavity was found to be full of blood clots; however, leaking of blood into the pericardial cavity had stopped, and there was a haematoma on the anterior wall of the left ventricle. Fibrin glue with a sheet of collagen was applied to the epicardial surface of the ruptured site. Left ventricular angiography, which was performed 30 days after acute myocardial infarction, showed anteroapical dyskinesis without leakage (upper panel, centre). Subsequent angioplasty of the left anterior descending artery and circumflex artery was successful.
Left ventricular angiography one year after the myocardial infarction showed a giant aneurysm on the anterior wall of the left ventricle (lower panel, centre). Transthoracic echocardiography (upper panel, right) and magnetic resonance imaging (lower panel, right) demonstrated a thin wall, a sack-like structure, and a mural thrombus. The pseudoaneursym was resected and the defect in the ventricular wall was closed.