Left ventricular pseudoaneurysms have become a rare complication of acute myocardial infarction, occurring in approximately 2% of cases and even less frequently when primary percutaneous intervention can be performed. Regardless of treatment strategy, left ventricle pseudoaneurysms are associated with a high mortality rate. We report on the extremely rare occurrence of a patient surviving two episodes of free wall rupture associated with extensive chest wall destruction and secondary traumatic rib fractures. The key to success in this case is related to both the cardiac and chest wall repair.;;The VideosVideos can be viewed in the online version of this article [http://dx.doi.org/10.1016/j.athoracsur.2016.09.007] on http://www.annalsthoracicsurgery.org.;Ventricular free wall rupture after acute myocardial infarction may be contained by adherent pericardium or scar tissue. This situation prevents the occurrence of immediate hemopericardium and cardiac tamponade and?results in the formation of a pseudoaneurysm, which is an extremely rare complication of myocardial infarction in the percutaneous coronary intervention era [1][1]. Regardless of treatment strategy, LV pseudoaneurysms are associated with a high mortality rate. Surgical repair is usually indicated owing to the possibility of subsequent complete cardiac rupture and death [2][2]. Afterward, successful surgery patients should be monitored closely with echocardiographic controls.Recurrence of LV pseudoaneurysms is exceedingly rare, with only a few cases described in the literature, generally related with repair patches implanted with sutureless techniques using fibrin glue [3][3]. Several factors may be related with recurrence after surgical correction of LV pseudoaneurysms. They involve areas of friable myocardium, and every effort should be made in order to place the sutures as far away from the rim of infarcted area as possible. Moreover, poor blood pressure control may cause significant increase of left ventricular pressure and wall stress, resulting in higher risk of suture failure. Experience with postmyocardial infarction ventricular septal defect patients show that, in the population of patients presenting with the mechanical complication, there is no benefit from revascularization procedures of the culprit coronary artery. Nevertheless, coronary angiography and revascularization of other related vessels with a large area of ischemia may decrease the possibility of suture dehiscence.The extensive cavity containing the recurrent cardiac rupture not only reached the chest wall; it also extended to the subcutaneous tissue. This subcutaneous herniation was associated with extensive musculoskeletal destruction and the occurrence of a pulsatile mass in the left thoracic region. To our knowledge, this is the first description of an LV pseudoaneurysm associated with secondary traumatic rib fractures.;Supplemental Video 1A pulsatile mass in the left submamilar region of the chest wall.
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