Conservative Management of an Iatrogenic Left Ventricular Pseudo Aneurysm After Type A Aortic Dissection Surgery.

Abstract

Background: Left ventricular pseudo aneurysm is a rare but potentially fatal complication after surgery for type A aortic dissection, due to the fragile nature of the pseudo aneurysm wall. This case highlights the critical role of cardiac magnetic resonance imaging (CMR) in diagnosis, monitoring, and guiding treatment decisions.

Case presentation: A 69-year-old male was readmitted 14 days post-ascending aortic replacement for type A dissection. Surveillance CT angiography revealed a 29 × 24 mm apical lesion with wall thinning, initially indeterminate on TTE but confirmed as a pseudoaneurysm by CMR. Initially undetected on transthoracic echocardiography due to limited acoustic windows, the pseudoaneurysm was definitively diagnosed and characterized by cardiac magnetic resonance imaging, which provided high-resolution tissue delineation and dynamic assessment of the ventricular apex. Given the patient's stable clinical status and comorbidities, a conservative approach was adopted with close follow-up using echocardiography and contrast-enhanced computed tomography angiography. The patient showed favorable evolution over time.

Conclusion: While surgical repair constitutes the gold-standard treatment for acute Stanford type A aortic dissections, conservative management may represent a viable alternative in select cases of post-surgical left ventricular pseudoaneurysm development, particularly in asymptomatic patients with stable hemodynamic parameters and no evidence of expansion or rupture. Cardiac magnetic resonance imaging provides critical diagnostic and prognostic value by identifying high-risk features-thereby guiding individualized therapeutic decision-making.