Recurrent Left Ventricular Apical Pseudoaneurysm at the Site of Previous Patch Repair; a Case Report

Our case was a 70-year-old male with a past history of coronary artery bypass graft surgery and true aneurysmectomy seven years ago who presented with chest pain and dyspnea. Echocardiography demonstrated scarred and aneurysmal apex (6.15 cm ×2.19 cm) with a small rupture just at most protruding part of it, to and from flow across this rupture site resulted in slow oozing of blood into pericardial sac with mobile clot in apex, clot formation in pericardial sac extended into both apical parts and distorted apical and apicoseptal geometry without communication with right ventricular cavity. Cardiac MRI (CMR) showed the following data: large apical pseudoaneurysm at the site of ruptured patch (depth: 46mm, width: 60mm), narrow orifice (5mm), septated left ventricular apical outpouching surrounded by apical layers and included clots in different sizes and ages. He underwent a successful surgical operation. In this case, CMR provides excellent images essential for patient management.