Left Ventricular Pseudoaneurysm Possibly Associated with Rivaroxaban Therapy Disappeared after Cessation of Rivaroxaban: Case Report and Literature Review.

INTRODUCTION: Although iatrogenic left ventricular pseudoaneurysm (LVPA) is rare, its treatment strategy needs consideration. We report a case in which postoperative initiation of rivaroxavan led to iatrogenic LVPA, which resolved spontaneously after drug cessation. CASE PRESENTATION: A 69-year-old man was diagnosed with a 76-mm saccular aortic arch aneurysm. He underwent urgent total aortic arch replacement with a frozen elephant trunk. A left ventricular apex injury due to intraoperative vent insertion was repaired, and postoperative CT revealed no problems. While hospitalized, he developed atrial fibrillation and started taking rivaroxavan. At 3 months postoperatively, an LVPA, 10 mm in diameter, developed at the intraoperative repair site. The LVPA resolved spontaneously following discontinuation of rivaroxaban, thereby avoiding the need for reoperation. CONCLUSIONS: This case illustrates the potential for anticoagulation-associated LVPA formation in surgically repaired myocardium and supports the consideration of conservative management in selected cases.