Abstract
<title>Abstract</title> <p>Background Left ventricular (LV) pseudoaneurysm is an uncommon but potentially fatal mechanical complication of acute myocardial infarction (AMI). It develops from a contained rupture of the ventricular free wall, with extravasated blood confined by pericardium and fibrous tissue rather than myocardium. Although timely reperfusion has reduced its incidence, delayed presentations continue to occur and carry a high risk of rupture if untreated. Early diagnosis through multimodality imaging and prompt surgical intervention are critical for successful outcomes. Case Presentation : A 66-year-old man with type 2 diabetes mellitus, hypertension, ischemic heart disease, and mildly reduced left ventricular systolic function presented with progressively worsening exertional dyspnea (New York Heart Association class III) three months after successful primary percutaneous coronary intervention (PCI) with stenting of the right coronary artery for inferior wall ST-elevation myocardial infarction. Transthoracic echocardiography and cardiac magnetic resonance (CMR) imaging revealed a giant submitral LV pseudoaneurysm with a narrow neck. Preoperative coronary angiography demonstrated a patent stent with only mild non-obstructive coronary artery disease. The patient underwent successful isolated left ventricular reconstruction using the Dor endoventricular circular patch plasty technique. His postoperative course was uneventful, with marked symptomatic improvement and stable left ventricular geometry on follow-up. Conclusion This case highlights the importance of suspecting LV pseudoaneurysm in patients with new or worsening heart failure symptoms months after myocardial infarction. Multimodality imaging, particularly CMR, plays a pivotal role in diagnosis and surgical planning. When significant obstructive coronary disease is absent, isolated Dor reconstruction provides an effective surgical option with favorable outcomes.</p>