''Lovely Heart'' on echocardiography: An unusual left ventricular pseudoaneurysm diagnosed incidentally.

Abstract

A-52-year old male patient, with a history of coronary bypass surgery (CABG) operation 2 years ago, was referred to our clinic for routine control. An echocardiography showed anterior segment hypokinesia and an aneurysmal sac communicating to posterolateral basal segment of the left ventricle (LV). LV ejection fraction was found reduced (42% by modified Simpson’s method). Interestingly in apical long -axis view the LV had the shape of “lovely heart” (Fig. 1A and Video 1). Shortaxis view showed two apex-like appearance (true and false apex) that clearly displayed dyskinesia of the pseudoaneurysm (Fig. 1B, C and Video 2-3). Computed tomography (CT) angiography was performed and showed thrombus formation inside the pseudoaneurysm (Fig. 1D). A 3D reconstruction of cardiac CT angiography allowed better understanding the nature of the pseudoaneurysm (Fig. 1E, F). LV pseudoaneurysm should be treated surgically because of high rupture risk. Surgery was recommended to the patient but he declined to undergo surgery and medical follow up was initiated.