Abstract
Despite advances in reperfusion therapy, acute myocardial infarction may still lead to rare, life-threatening mechanical complications. We describe the case of a 58-year-old man who developed progressive heart failure two months after an untreated anterior myocardial infarction. Multimodality imaging demonstrated a large left ventricular apical pseudoaneurysm with post-infarction ventricular septal rupture into the right ventricle, resulting in a significant left-to-right shunt. The patient underwent successful aneurysmectomy, closure of the septal defect, and coronary artery bypass grafting. This report highlights a rare combination of mechanical complications following delayed reperfusion and emphasizes the essential role of imaging in diagnosis and surgical planning. Given its rarity and complexity, this case contributes to the understanding of structural sequelae of myocardial infarction.