Twin pseudo-aneurysms secondary to mid-ventricular disruption following mitral valve replacement

Development of left ventricular pseudo-aneurysm following mitral valve replacement is rare. Subannular pseudoaneurysm due to separation of the mitral annulus from the free wall following excessive traction or debridement has been reported since long. Aneurysm formation following excision of papillary muscles and mitral leaflets or spontaneous mid-ventricular rupture of the thin ventricle has been rarely reported. This report describes a middle-aged woman who developed heart failure three months after mitral valve replacement. She was detected to have pseudo-aneurysms of the left ventricular free wall and of the posterior wall at locations which initially bore bases of the papillary muscles. This entity of twin mid-ventricular pseudo-aneurysms as a result of mechanical trauma during mitral valve replacement is very rare and has not been reported earlier.