Pseudoaneurysm of the Left Ventricle following Mitral Valve Replacement

¹ Cardiovascular and Radiology Departments, St. Mary's Long Beach Hospital, Lon Beach, California

Two patients with prosthetic mitral valves demonstrated clinical deterioration and were found by left ventriculography to have pseudoaneurysms of the inferior left ventricular wall. Both patients had lysis of pericardial adhesions at the time of valve replacement surgery and also had moderate aortic regurgitation. It is possible that myocardial trauma secondary to dissection of adhesions or from overzealous sucker recovery of aortic regurgitant flow was sufficient to result in subsequent myocardial dehiscence. Both patients had loud apical systolic murmurs. The inferior location of the aneurysms prevented correct diagnosis before left ventriculography had been performed. The importance of left ventriculography in evaluating periprosthetic systolic murmurs is emphasized. We have not found previously reported cases of pseudoaneurysm formation following heart surgery in which no left ventricular incision had been made.