一位八十二歲男性於七十二歲時急性心肌梗塞後併發左心室偽瘤。冠狀動脈攝影顯示左
主冠狀動脈和三條冠狀動脈疾病；左心室攝影發現下後壁有一條狀偽瘤。他接受冠狀動脈繞
道手術但因偽瘤週邊組織皆壞死，所以無法以折疊術處理左心室偽瘤。最近的經胸心臟超音
波檢查顯示左心室下後壁運動低下、左心室收縮功能不良（射血分率為44%）、左心室下後壁
有一偽瘤。此病患於心肌梗塞十年後仍存活良好。這預後可是能因為偽瘤內的組織化血栓、
積極的藥物治療和冠狀動脈繞道手術。雖然此個案以非外科治療後存活十年多，但我們無法
以此個案論證以後所有急性心肌梗塞後併發左心室偽瘤病患皆可只接受保守治療。

An 82 years old man developed a left ventricular pseudoaneurysm after acute myocardial infarction
when he was 72 years old. Coronary angiography showed left main and triple-vessel coronary artery
disease. On left ventriculography, a tubular-like pseudoaneurysm was demonstrated that originated from the
basal inferoposterior wall of the left ventricle. He underwent coronary artery bypass surgery with no plication
of the pseudoaneurysm because the surrounding tissues of pseudoaneurysm were all necrotic. The most
recent follow-up transthoracic echocardiography revealed a hypokinetic basal inferior wall, impaired LV
contraction with an ejection fraction of 44%, and an inferoposterior wall pseudoaneurysm. The patient was
doing well more than 10 years after the myocardial infarction. The prognosis might be determined by the
organized thrombi, aggressive pharmacologic treatment, and coronary artery bypass surgery. Although our
patient has survived for more than 10 years with a nonsurgically treated post-infarction LV pseudoaneurysm,
we could not provide an evidence to support that conservative therapy is enough for every patient with a
post-infarction pseudoaneurysm. (J Intern Med Taiwan 2012; 23: 442-448)