# Transatrial repair of a giant left ventricular pseudoaneurysm and ischaemic mitral regurgitation after myocardial infarction: case report

## TL;DR

A 77-year-old man with a giant heart pseudoaneurysm and severe valve leak underwent successful surgery to repair both conditions, despite post-operative complications.

## Contribution

Presents a successful surgical approach for treating giant LVPA and mitral regurgitation using a transatrial method.

## Key findings

- Transatrial patch closure and mitral valve replacement successfully treated a giant LVPA and severe mitral regurgitation.
- The patient was discharged with good functional status after 1 month of renal replacement therapy.
- The transatrial approach reduced surgical trauma and protected the left ventricle from rupture.

## Abstract

Left ventricular pseudoaneurysm (LVPA) is an infrequent but highly lethal complication of myocardial infarction. Early surgical repair with a resection of pseudoaneurysm is often performed, given that medical therapy alone is associated with a high risk of mortality. This report describes a case of a giant LVPA on the lateral wall post-infarction and mitral valve regurgitation that was successfully treated by surgical transatrial closure and mitral valve replacement.

A 77-year-old man with chronic kidney disease and a history of percutaneous coronary interventions for acute myocardial infarction was referred to the cardiac surgeons because of a spontaneous finding of an abnormal mass adjacent to the heart on imaging studies, which was missed on a chest radiograph obtained 3 months earlier. Cardiac studies revealed LVPA and severe mitral regurgitation with poor ejection fraction. Early repair of LVPA and concurrent mitral valve surgery were recommended. Transatrial patch closure and mitral valve replacement were performed using an interatrial approach via median sternotomy. Although the patient’s post-operative course was complicated by congestive heart failure and irreversible renal failure, he was discharged with good functional status after 1 month of intermittent renal replacement therapy with haemodialysis.

Transatrial repair of LVPA and concurrent mitral valve replacement can be a treatment of choice for reducing surgical trauma to the left ventricle and protecting the sealing structure from rupture.