Late Chronic Left Ventricular Pseudoaneurysm Thrombosis

Background: Left ventricular pseudoaneurysm (LVPA) is a rare but serious complication following myocardial infarction, often leading to thrombus formation and hemodynamic collapse. Case Summary: We present 2 cases of LVPA in patients with a history of myocardial infarction. A 61-year-old man underwent surgical repair for a large apical LVPA with significant thrombus formation, and a 77-year-old woman with a posterolateral LVPA was treated with percutaneous exclusion. Echocardiography and cardiac computed tomography were used in the diagnosis in both cases, highlighting the delayed presentation of LVPA. Discussion: LVPA, though rare, poses a high risk for rupture and thrombotic complications. Early recognition is crucial for timely intervention. These cases are of interest owing to the large size of the pseudoaneurysms and the distinct therapeutic approaches used. Take-Home Message: LVPA can manifest years after myocardial infarction, and timely intervention, whether surgical or percutaneous, is key to improving outcomes in such cases.