Percutaneous closure of a giant left ventricular pseudoaneurysm using an Amplatzer muscular VSD occluder in a high-risk patient with recurrent heart failure following multiple myocardial infarctions

Background – Left ventricular pseudoaneurysm (LVPA) is a rare and potentially fatal complication of myocardial infarction (MI), with mortality reaching 48% in untreated patients. While surgical repair has been the conventional therapy, perioperative mortality of 10%–36% renders it prohibitive in patients with multiple comorbidities. Percutaneous transcatheter closure has emerged as a life-saving alternative for high-risk surgical candidates. Case report – A 75-year-old male with prior coronary artery bypass grafting (2010) and two subsequent myocardial infarctions (2019 and 2020) treated with percutaneous coronary intervention presented with refractory decompensated heart failure, massive left pleural effusion, and markedly elevated NT-proBNP (7, 172 pg/mL). Cardiac magnetic resonance imaging revealed a giant LVPA (61 mm × 28 mm; end-diastolic volume 55 mL) arising from the lateral-to-posterolateral wall, with transmural late gadolinium enhancement confirming a post-infarction etiology. After multidisciplinary heart-team consensus, percutaneous transcatheter closure was performed via a transfemoral retrograde approach under transesophageal echocardiographic guidance using a 16 mm Amplatzer Muscular VSD Occluder. The procedure was uncomplicated, with no significant residual flow. The patient was discharged on postoperative day 2. At 3-month follow-up, he was in NYHA class I-II with marked symptomatic improvement, NT-proBNP reduction to ∼500 pg/mL, and no residual flow. Conclusions – Percutaneous transcatheter closure with an Amplatzer Muscular VSD Occluder is a feasible, safe, and life-saving therapeutic option in selected high-risk patients with post-infarction LVPA presenting with refractory heart failure.