Giant Compressive Pseudoaneurysm of the Anterior Wall of the Left Ventricle Following Cardiac Surgery of Aortic Endocarditis: A Case Report

Background: Left ventricular pseudoaneurysm (LVP) is a rare but serious clinicopathologic entity. LVP is very uncommon in infective endocarditis, it may complicate the clinical course of infective endocarditis or occur postoperatively. Case presentation: We describe the case of a 10-year-old patient with a history of aortic vegetation resection with aortic valve repair for Staphylococcus Aureus infective endocarditis of the aortic valve complicated by a periaortic abscess and who presented nine months after surgery with exertional dyspnea revealing a giant pseudoaneurysm of the anterior and anteroseptal wall of the left ventricle extended anteriorly in front of the right atrium, the pulmonary infundibulum and the pulmonary artery and extended to the level of the aortic arch, with two neo cavities, one right and the other left measuring 73 × 59 mm and 16 × 17 mm respectively, responsible for compression of the pulmonary artery associated with severe aortic regurgitation secondary to total retraction of the antero-right cusp. The diagnosis was established by transthoracic echocardiography and computed tomography angiography of the chest. Urgent cardiac surgery is performed with excision of the pseudoaneurysm and direct closure of the defect, combined with replacement of the aortic valve with bioprosthetic valve. unfortunately, the patient died early post-op a few hours after leaving the operating theatre. Conclusions: LVPA due to infective endocarditis is rare and can be promoted by the abscess formation in the left ventricular myocardium. This case illustrates the fatal nature of this complication and encourages us to ensure regular and close post-operative monitoring despite satisfactory early post-operative control.