Safety and tolerability of Sacubitril/Valsartan in heart failure patient with reduced ejection fraction.

BACKGROUND: Angiotensin receptor blocker and a neprilysin inhibitor (ARNI) has emerged as an innovative therapy for patients of heart failure with reduced ejection fraction (HFrEF). The purpose of this study was to assess the safety and tolerability of Sacubitril/Valsartan in patient with HFrEF in Pakistani population. METHODS: This proof-of-concept, open label non-randomized clinical trial was conducted at a tertiary care cardiac center of Karachi, Pakistan. Patients with HFrEF were prescribed with Sacubitril/Valsartan and followed for 12 weeks for the assessment of safety and tolerability. Safety measures included incidence of hypotension, renal dysfunction, hyperkalemia, and angioedema. RESULTS: Among the 120 HFrEF patients, majority were male (79.2%) with means age of 52.73 ± 12.23 years. At the end of 12 weeks, four (3.3%) patients died and eight (6.7%) dropped out of the study. In the remaining 108 patients, 80.6% (87) of the patients were tolerant to the prescribed dose. Functional class improved gradually with 75.0% (81) in class I and 24.1% (26) in class II, and only one (0.9%) patient in class III at the end of 12 weeks. Hyperkalemia remains the main safety concern with incidence rate of 21.3% (23) followed by hypotension in 19.4% (21), and renal dysfunction in 3.7% (4) of the patients. CONCLUSIONS: Sacubitril/Valsartan therapy in HFrEF patients is safe and moderately tolerated among the Pakistani population. It can be used as first line of treatment for these patients. TRIAL REGISTRATION: NCT05387967. Registered 24 May 2022-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05387967.

Ten years risk assessment of atherosclerotic cardiovascular disease using Astro-CHARM and pooled cohort equation in a south Asian sub-population.

BACKGROUND: Atherosclerotic cardiovascular diseases (ASCVD) are on the rise in low and middle-income countries attributed to modern sedentary lifestyle and dietary habits. This has led to the need of assessment of the burden of at-risk population so that prevention measures can be developed. The objective of this study was to assess ten years risk assessment of ASCVD using Astro-CHARM and Pooled Cohort Equation (PCE) in a South Asian sub-population. METHODS: A total of 386 residents of all six districts of Karachi with no ASCVD were enrolled in the study through an exponential non-discriminative referral snowball sampling technique. The inclusion criteria consisted of age 40 years or above and either gender. Study participants were enrolled after obtaining informed written consent and those study participants who were found to have either congenital heart disease or valvular heart diseases or ischemic heart disease were excluded from the study based on initial screening. For the calculation of 10 years risk of ACVD based on Astro-CHARM and PCE, the variables were obtained including medical history and coronary artery calcium and C-reactive protein measurements. RESULTS: Mean estimated 10-year risk of fatal or non-fatal myocardial infarction or stroke as per the Astro-CHARM was 13.98 ± 8.01%, while mean estimated 10-year risk of fatal or non-fatal myocardial infarction or stroke as per the PCE was 22.26 ± 14.01%. Based on Astro-CHARM, 11.14% of the study participants were labeled as having high risk, while PCE estimated 20.73% of study participants as having high risk of ASCVD. CONCLUSION: Despite the fact that our findings showed substantial differences in ten-year risk of ASCVD between Astro-CHARM and PCE, both calculators can be used to develop a new population and specific risk estimators for this South Asian sub-population. Our study provides the first step towards developing a risk assessment guided decision-making protocol for primary prevention of ASCVD in this population.

Risk of Atherosclerotic Cardiovascular Diseases in various Ethnicities of Pakistan.

OBJECTIVE: To estimate the risk of atherosclerotic cardiovascular diseases (ASCVD) in various ethnicities of Pakistan using Astronaut Cardiovascular Health and Risk Modification (Astro-CHARM) risk calculator and the Pooled Cohort Equations (PCE). METHODS: Individuals of both gender between 40 to 65 years of age without pre-existing coronary artery disease from residents of Karachi were recruited through snowball sampling technique. Study was conducted at the National Institute of Cardiovascular Diseases, Karachi, Pakistan during January to June 2019. Ethnicity of the participants was categorized based on their mother tongue. Ten-year risk of ASCVD event was estimated using Astro-CHARM Calculator and PCE. RESULTS: Mean age of a total of 386 individuals was 49(±7.1) years and 45.3% (175) were females. Urdu-speaking individuals were 33.4%(129) of the sample, while, 18.4%(71) Pushtoons, 14%(54) Sindhi, 13%(50) Punjabi, 2.6%(10) Balochi, and remaining 18.7%(72) were of other ethnicities. High risk (≥7.5%) individuals were 20.7% (80/386) as per PCE and 11.1% (43/386) as per Astro-CHARM. As per Astro-CHARM, Sindhis' had the least risk of ten-years ASCVD event among all the ethnicities, while, Urdu-speakings' had the highest risk with mean rank of 145.18 vs. 216.50, p-value=0.001. CONCLUSION: A significant 10-years risk of first ASCVD event was observed in our population. ASCVD risk is alarmingly high in some ethnicities, such as Urdu-speaking, owing to the increased prevalence of traditional modifiable risk factors, such as diabetes and smoking.

Imbalances of Pro-inflammatory cytokines in myocardial infarction patients.

To assess levels of Interleukin-1 ß and CRP, in Diabetic and Non-diabetic Myocardial Infarction patients, prior to and post angioplasty. 200 patients were recruited in the study. MI patients between the age of 40 and 60 years. Patients came to NICVD with complaints of chest pain, positive Troponin T test and ECG was the confirmatory test for MI. They were divided into 2 groups 100 patients each. First group comprised of MI patients without DMT-II and second group comprised of MI patients with DMT-II. Serum triglycerides, cholesterol, LDL and HDL, FBS, by enzymatic kits, Insulin by RIA. HbA1C, Interleukin-1 ß and CRP by ELIZA. Interleukin1ß and CRP were significantly higher (P<0.001) in patients at the time of the infarction, prior to angioplasty as compared post angioplasty levels in both groups, which indicate their importance in development of ischemia and MI. FBS and Insulin were significantly higher (P<0.001), while HDL and HbA1C were significantly lower (P<0.001) in MI without DMT-II when compared to MI with DMT-II. BMI, SBP pressure were significantly higher (P<0.001) in MI patients with DMT-II when compared with MI patients without DMT-II. Interleukin1ß and CRP were found to be significantly higher prior to angioplasty as compared to post angioplasty levels in both groups which confirms their role in development of ischemia and MI.

Central venoplasty in AV (Arteriovenous) fistula dysfunction a palliative endovascular approach.

The ultimate treatment of chronic kidney disease is renal transplant. Patients with CKD who need temporary haemodialysis have to have indwelling catheters. The catheters used are either temporary or permacath (A permacath is a piece of plastic tubing very similar to jugular catheter used for haemodialysis). The issues with these catheters are stenosis of central vein especially subclavian. Central venous stenosis leads to impairment in optimal dialysis. We report two cases of central venous stenosis in which patients presented with pain and oedema of the arm. Venogram showed totally occluded right subclavain vein and left innominate vein. Venoplasty was done which on followup showed a normalization of arm and resumption of dialysis through AV fistula. .

Estimating risk of atherosclerotic cardiovascular diseases in non-atherosclerotic Pakistani patients: Study conducted at National Institute of Cardiovascular Diseases, Karachi, Pakistan.

OBJECTIVE: To assess ten-year and lifetime estimated cardiovascular disease risks in non-atherosclerotic subjects. METHODS: This cross-sectional study was carried out at the National Institute of Cardiovascular Disease, Karachi, from July 2014 to March 2015, and comprised male and female subjects with multi-ethnic background, aged 20-79 years and having non-atherosclerotic disease. SPSS 22 was used for data analysis. RESULTS: Of the 437 participants, 174(39.8%) were men and 263(60.2%) were women. The overall mean age was 42.65±11.45 years. The mean age of men was 43.3±12.1 years and that of women was 42.2±10.8 years. Moreover, ten-year and lifetime risk assessment rates were higher in men (50[28.2%] and 86[49.4%] respectively) compared to women (28[10.6%] and 84[31.9%], respectively). CONCLUSIONS: Urdu-speaking Pakistanis were found to be at higher risk from atherosclerotic cardiovascular disease.

Regression of right ventricular systolic pressure after successful percutaneous mitral commissurotomy in patients with isolated severe mitral stenosis.

OBJECTIVE: To know the regression of right ventricular pressure after successful percutaneous transluminalmitral commissurotomy (PTMC) in patients with severe isolated mitral stenosis. METHODS: This descriptive study was performed in inpatient and outpatient department of National Institute of Cardiovascular Disease from 1st February 2016 to 31st August 2016. Echocardiography of all patients with successful PTMC were recorded 24 hours and 06 months following PTMC to see for Regression of right ventricular pressure along with other baseline echocardiographic parameters. RESULTS: A total of 99 patients with severe isolated mitral stenosis who had undergone successful PTMC were studied. Females were 65(65.7%) and males 34(34.3%). Mean age was 27.44±6.26 years. TTE performed before and after PTMC showed significant difference in mean mitral valve area (0.89cm ±0.089cm2 vs. 1.68±0.128 cm2, p valve <0.001) and mean left atrial diameter (4.66± .82cm vs. 4.46± 0.65cm). Mean mitral valve gradient pre PTMC was significantly higher (16.38±2.51 mm of Hg) than that of post PTMC 24 hours (4.75±1.31 mm of Hg) and Post PTMC 06 months (5.22±1.21 mm of Hg), p valve <0.001. Mean right ventricular systolic pressure (RVSP) pre PTMC was significantly higher 62.3±10.91 mm of Hg than that of post PTMC 24 hour's 57.51±9.67 mm of Hg and post PTMC 06 moths 46.49±7.8mm of Hg, p value 0.001. Mean LVEF 50.14± 5.82. CONCLUSION: There was a significant regression of right ventricular pressure following successful PTMC in mid-term (06 months) follow up of severe isolated mitral stenosis patients.

Burden Of Atherosclerosis Risk Among Different Ethinicity: A Hidden Health Challenge.

BACKGROUND: Atherosclerosis risk and incidence of developing chronic cardiovascular conditions vary greatly between ethnic groups in South Asian population. To evaluate different ethnic groups in Pakistan, population based study was conducted at Karachi, the largest metropolitan city of Pakistan; to assess ten years and lifetime estimated cardiovascular disease risks without preexisting cardiovascular disease in Pakistani subjects by using Pooled Cohort Risk equation (calculator) as per American College of Cardiology (ACC) and the American Heart Association (AHA) 2013 guidelines. METHODS: For the study, consecutive subjects (n=437) with multi-ethnic background, aged 20-79 years and having non-atherosclerotic disease were enrolled at site of National Institute of Cardio-Vascular Diseases (NICVD), Karachi, Pakistan. RESULTS: Within each ethnic group and overall, the risk of developing atherosclerosis was common in all ethnic groups especially Urdu speaking are mostly at the high with all the factors above the borderline values, followed by Punjabis and Pathans that may point toward associated higher risk for prevalence of cardiovascular disease. These ethnic groups showed increased prevalence of dyslipidemia, obesity, and much greater abnormalities asunique risk. Although there are differences in these altered factors but the changes in lifestyle, urbanization, genetic profile and physiological makeup are the main reasons that could be a trigger to increase cardiovascular events. CONCLUSIONS: The present study provides the first evidence and may serve as useful guidance to calculate the estimated risk both 10 years and lifetime in the non-atherosclerotic Pakistani population with different ethnic background.

Endovascular treatment of a post catheterization pseudoaneurysm: A stitch in time saves nine.

External iliac artery (EIA) pseudoaneurysms are a well-known complication after arterial catheterization procedures. Most develop as a result of high femoral puncture. Small asymptomatic pseudoaneurysms are usually of no consequence but large symptomatic pseudoaneurysm carries a significant risk of rupture with serious life-threatening consequences and needs to be treated. We report here a case of EIA pseudoaneurysm in a 60 year old male patient after a cardiac catheterization procedure. CT angiography demonstrated a large pseudoaneurysm arising from the EIA and compressing the urinary bladder. Patient complained of abdominal pain and felt dizzy and required transfusions due to rapidly developing anaemia secondary to blood loss. Conventional angiography revealed free extravasation of contrast from the EIA. Percutaneous intervention through femoral access was performed by deploying a covered stent which effectively sealed off the perforation site with no evidence of contrast extravasation.

Left atrial appendage thrombus with severe mitral stenosis: Responders and non-responders to anticoagulation.

INTRODUCTION AND OBJECTIVE: Mitral stenosis (MS) is one of the most frequently observed valvular heart lesions in developing countries and is due to different etiologies. The effects of anticoagulation in different types of left atrial appendage (LAA) are unknown. The current study aimed to determine the resolution of LAA thrombus on transesophageal echocardiography (TEE) after three months of optimal anticoagulation in patients with different types of LAA at baseline cardiac computed tomography of patients with severe MS. METHODS: This prospective cohort study observed the frequency of LAA thrombus resolution after three months of anticoagulation therapy in patients with severe MS. The response rate in different morphologies of LAA and locations was also assessed. Thrombus resolution after three months of warfarin therapy was assessed on repeat TEE. RESULTS: A total of 88 patients were included, mean age 37.95±11.87 years. Repeat TEE showed thrombus resolution in only 27.3% of patients. The rate of thrombus resolution was 8/12 (66.7%), 4/28 (14.3%), 8/36 (22.2%), and 4/12 (33.3%) for patients with cactus, cauliflower, chicken wing, and windsock LAA type, respectively. The resolution rate was 0/12 (0%), 4/44 (9.1%), and 20/32 (62.5%) for patients with thrombus in the base, body, and tip of the LAA, respectively. CONCLUSION: The cactus type of LAA morphology and thrombus at the LAA tip responded well to three months of anticoagulation, however, patients with thrombus in the LAA base and body and cauliflower and chicken wing morphology were non-responders and could benefit from early referral for surgical management.

Impact of educational intervention on hypertension management by primary care physician: A randomized control trial.

Objective: The current study aimed to observe hypertension educational intervention's effect on general physicians (GPs) to improve blood pressure control and patient outcomes indirectly. Methods: This randomized control trial includes 42 GPs divided into 2 groups. GPs in group 1 receive face-to-face education with structured educational material on hypertension management strategies by a senior cardiologist. GPs in group 2 receive the print version of education material. The data was collected from six major cities in Pakistan. GPs with at least three years of experience in the broad primary care disciplines, with ages above 18 years, were included in the study. Results: A total of 42 physicians (21 from each group) completed questionnaires, while out of 420 hypertension patients, 105 newly diagnosed and already diagnosed patients enrolled under physicians of both groups. The educational material did just as well at informing clinicians as the face-to-face group intervention did and both the interventions had a significant effect on knowledge and BP control. Conclusion: After the 3-month follow-up, both interventions, including face-to-face and educational approaches, demonstrated significant effectiveness in improving knowledge and blood pressure control. Innovation: The study shows that hypertension educational intervention's effect on general physicians indirectly improves blood pressure control and patient outcomes. And emphasize for developing a hypertension educational program targeted at general physicians.

Expert recommendations for the management of iron deficiency in patients with heart failure in Asia.

BACKGROUND: Iron deficiency is a common comorbidity in heart failure (HF) and is independently associated with a worse quality-of-life and exercise capacity, as well as increased risk of hospitalization, regardless of anemia status. Although international guidelines have provided recommendations for the management of iron deficiency in patients with HF, guidelines in Asia are less established, and practical use of guidelines for management of iron deficiency is limited in the region. METHODS: A panel comprising cardiologists from China, Hong Kong, India, Japan, Malaysia, Pakistan, Philippines, Singapore, South Korea, Taiwan, and Thailand convened to share insights and provide guidance for the optimal management of iron deficiency in patients with HF, tailored for the Asian community. RESULTS: Expert opinions were provided for the screening, diagnosis, treatment and monitoring of iron deficiency in patients with HF. It was recommended that all patients with HF with reduced ejection fraction should be screened for iron deficiency, and iron-deficient patients should be treated with intravenous iron. Monitoring of iron levels in patients with HF should be carried out once or twice yearly. Barriers to the management of iron deficiency in patients with HF in the region include low awareness of iron deficiency amongst general physicians, lack of reimbursement for screening and treatment, and lack of proper facilities for administration of intravenous iron. CONCLUSIONS: These recommendations provide a structured approach to the management of iron deficiency in patients with HF in Asia.

Failed percutaneous mitral commisurotomy due to congenital anomaly of inferior vena cava.

Since its inception in 1982, percutaneous transvenous mitral commissurotomy (PTMC) has gained increasingly wide use internationally in patients with Rheumatic Mitral stenosis. PTMC offers an alternative to surgery in patients who have pliable mitral valve.Very few reasons were reported to abort the procedure when patient lies on the table. This study presents two case reports in which congenital venous anomalies were one of the reasons to terminate the procedure.

Primary percutaneous coronary intervention in a patient with dextrocardia.

The case of a 40-year-old male with dextrocardia who presented with ST Elevated Myocardial Infarction (STEMI) is reported. Coronary angiogram was performed after due manipulation and then successful primary percutaneous coronary intervention (PCI) of Left anterior descending (LAD) coronary artery was done. His 9 months follow up primary PCI in a patient with angiogram revealed patent stent in proximal LAD. There are very few published case reports of this rare congenital anomaly addressing technical details of successful primary PCI with dextrocardia.

The outcome of primary percutaneous coronary intervention in patients with stent thrombosis.

BACKGROUND: Primary percutaneous coronary intervention (PCI) is a recommended management strategy for patients with de novo ST-segment elevation myocardial infarction (STEMI). Still, the efficacy of primary PCI in-stent thrombosis (ST) induced STEMI is unclear. The aim was to assess the clinical characteristics and the in-hospital outcomes of patients undergoing primary PCI for STEMI caused by acute, sub-acute, or late ST. METHODS: A sample of hundred consecutive patients who presented with STEMI due to ST were included in this study. The angiographic evidence of a flow-limiting thrombus or total vessel occlusion (thrombolysis in myocardial infarction (TIMI) flow grade 0 to II) at the site of the previous stent implant was taken as ST. Primary PCI was performed, and all enrolled patients and in-hospital mortality were observed. RESULTS: Male patients were 69, and the mean age was 58.9 ± 7.78 years. ST was categorized as acute in 40 patients, sub-acute in 53, and late in the remaining seven patients. Killip class III/IV was observed in 45 patients. Dissection was observed in 25, under deployment in 74, and/or malposition in 24 patients. Thrombus aspiration was performed in 97, plain old balloon angioplasty in 76, and stenting in 22 patients. Final TIMI III flow was achieved in 32 patients. During a mean hospital stay of 4.93 ± 2.46 days, the mortality rate was 27%. CONCLUSION: In-hospital mortality after primary PCI was observed in more than 1/4th of the patients with STEMI due to ST undergoing primary PCI.

Frequency of metabolic syndrome in patients with ischaemic heart disease.

OBJECTIVE: To evaluate the frequency of metabolic syndrome in patients with Ischaemic Heart Disease. METHODS: This was a cross sectional observational study. Patients with a first time cardiac event arriving in emergency room during the period October 2009 to April 2010, were included. Five components of Metabolic syndrome were defined according to criteria set by International Diabetes Federation, American Heart Association & National Heart, Lung and Blood Institute which had abdominal obesity (waist circumference) as an integral part of the syndrome. Blood sugar, triglycerides, HDL-C were measured within 24 hrs of cardiac insult. Hypertension was defined as blood pressure > 130/85 mmHg. Variables were integrated for descriptive statistics. RESULTS: A total of 477 patients diagnosed with Ischaemic Heart Disease were inducted in the study. There were 355 (74%) males and 122 (26%) females. Frequency of metabolic syndrome in Ischaemic heart disease was seen in 195 (54.95%) males and 96 (78.7%) females (p < 0.001). According to recent criteria abdominal obesity was observed in 91 (81.1%) females as compared to males 219 (61.7%) (p < 0.001) Similarly, low HDL and Hypertension were high in frequency in females. No significant difference in triglycerides levels was found in either gender. CONCLUSION: Frequency of metabolic syndrome with Ischaemic heart disease was high in females as compared to males. This could be attributed to the increased prevalence of abdominal obesity.

Assessment of renal insufficiency in patients with normal serum creatinine levels undergoing angiography.

OBJECTIVE: To determine the frequency of patients with underlying renal insufficiency having normal serum creatinine level proceeding for coronary angiography. METHODS: A total of 693 patients from September 2009 to February 2010 undergoing diagnostic coronary angiography at the National Institute of Cardiovascular Diseases (NICVD) with normal serum creatinine < 1.5 mg/dl were selected. Glomerular filtration rate (GFR) was calculated for each patient using the Cockcroft-Gault (C-G) equation and a GFR < 80 ml/min was labeled as renal insufficiency. RESULTS: The mean age of males was 51.86 +/- 10.19 years and 51.52 +/- 9.80 years for females. Almost one-third (n=236, 34.1%) of patients had GFR <80 ml/min; comparison between male (n=168, 31.2%) and female (n=68, 43.9%) was significant (p-value 0.003). Age group breakdown showed majority of patients (n=196; 83.05%) with GFR <80 ml/min ranged between 40-69 years (p-value 0.001). CONCLUSION: This study has shown that most of the patients with normal serum creatinine have abnormal GFR. Serum creatinine, which is considered to be an important screening test in patients with renal impairment, might remain in the normal range despite the renal function being significantly impaired. Therefore, GFR should be considered as an estimate of renal insufficiency, regardless of serum creatinine levels being in normal range.

Size of radial and ulnar artery in local population.

OBJECTIVE: To evaluate radial and ulnar artery diameter in patients undergoing diagnostic coronary angiography. METHOD: This was a cross-sectional study in which we measured the inner diameter of radial and ulnar artery by using two dimensional ultrasound and Doppler examination in 251 patients visiting our hospital for diagnostic coronary angiography between February to September 2008. RESULTS: The mean diameter of right and left radial artery was 2.3 +/- 0.4 mm and 2.2 +/- 0.4 mm respectively. The mean diameter of right and left ulnar artery was 2.4 +/- 0.4 mm and 2.3 +/- 0.3 mm respectively. The factors found to positively influence the size of radial artery included male sex, diabetes mellitus and smoking. There was no relationship of the size of the radial and ulnar artery with body size parameters (height, weight, Body Surface Area (BSA) & Body Mass Index (BMI). CONCLUSION: We conclude that ulnar artery diameter is larger than the radial artery in our population. Knowing the size will guide the interventional cardiologist in using appropriate size sheaths and guide catheters. Cardiac surgeons can utilize ulnar artery for bypass grafting when it is deemed unsafe to harvest the radial artery.

Abdominal obesity pattern among various ethnic groups presenting with acute coronary syndrome.

BACKGROUND: Abdominal obesity is an increasing public health problem and is associated with a number of cardiovascular risk factors. The aim of this study was to determine the frequency of abdominal obesity and associated risk factors in patients of various ethnic groups presenting with acute coronary syndrome. METHODS: A total of 477 patients presenting with acute coronary syndrome to the National Institute of Cardiovascular Diseases, Karachi were studied. The sample was divided into 5 major ethnic groups, Muhajir, Punjabi, Sindhi, Pathan, Baluchi and Others. Waist circumference of each patient was taken at the level of iliac crest and abdominal obesity was defined according to the International Diabetes Federation criteria of 2005 for South Asians as waist circumference > or = 90 Cm in males and > or = 80 Cm in females. Patients were also assessed for diabetes mellitus, hypertension, smoking, low HDL and elevated triglycerides. RESULTS: Out of 477 patients (355 males, 122 females), abdominal obesity was present in 318 (67%) patients, 62% of males and 81% of females were obese. Abdominal obesity was 62% in Muhajir, 78% in Punjabi, 67% in Sindhi, 68% in Pathan, 59% in Baluchi and 64% in others. Hypertension was present in 46%, Diabetes mellitus in 32%, Smoking in 33%, Low level of High density lipoprotein in 85.5% and raised triglycerides in 35% of patients. CONCLUSION: Abdominal obesity in Punjabi ethnic group is more common as compared to other ethnic groups. Low level of high density lipoprotein is almost universally present in patients with acute coronary syndrome.

Left ventricular aneurysmectomy in a young female with pseudoaneurysm of unknown etiology.

A left ventricular pseudoaneurysm is formed when there is free wall rupture of the myocardial wall with discontinuity and roof covered by pericardium mural thrombus or fibrous tissue without any myocardium. A left ventricular pseudoaneurysm is a rare and life-threatening event. We report a young 22-year-old female with unknown etiology of a pseudoaneurysm, who was previously managed as a psychiatric case and for musculoskeletal pain. On subsequent investigation and confirmation with cardiac magnetic resonance imaging, aneurysmectomy was done. This is a rare case in a young 22-year-old woman with a ventricular pseudoaneurysm of unknown etiology. Considering the high risk for rupture of a ventricular pseudoaneurysm, surgical resection was mandatory with no complications intra- and post-procedure.