Myocardial infarction with non-obstructive coronary arteries (MINOCA) is clinically defined by the universal acute myocardial infarction (AMI) criteria, absence of obstructive coronary artery disease (≥50% stenosis), and no overt cause for the presentation at angiography.¹ The underlying causes of MINOCA vary widely. However, excessive focus on determining etiology has resulted in limited clinical efforts.² Consequently, unexplained cases of MINOCA present challenges in risk stratification. Recent studies show that cardiac magnetic resonance imaging (CMR) identifies underlying causes in 87% of patients with MINOCA.³ Given difficulties in CMR access, potential evaluation issues, rising healthcare costs, and economic constraints, diagnostic challenges have gained precedence.

Several studies indicate that MINOCA has a consistently better prognosis than AMI.^1,3-5 However, MINOCA’s diverse etiologies⁶ complicate generalization of findings for diagnosis and treatment, meaning prognosis is not as benign as it may seem. Patients with MINOCA frequently experience recurrent symptoms, with 16% reporting worsening or persistent chest pain within 5 years.⁷ Some patients progress to occlusive coronary artery disease,⁸ so persistent chest pain should not be assumed to be MINOCA-related.

Left ventricular aneurysms, a potentially fatal condition, can lead to heart failure, systemic embolism, ventricular arrhythmia, and cardiac rupture, typically following AMI. The likelihood of aneurysm development increases with prolonged symptom-balloon time after AMI, and correlating symptom-balloon time with the patient’s syntax score enhances predictive value.⁹

While left ventricular apical aneurysms are rare in MINOCA,¹⁰ they have not previously been reported to cause left ventricular basal pseudoaneurysms. A left ventricular basal pseudoaneurysm with intraoperative imaging (Figure 1a-f) was identified in a 40-year-old female with chest pain diagnosed with non-ST-elevation myocardial infarction. Normal coronary arteries were observed, leading to a MINOCA diagnosis. A left ventricular basal pseudoaneurysm was confirmed by cardiac computed tomography and CMR, leading to referral for surgical treatment.

Post-AMI left ventricular aneurysms are associated with more complications, longer hospital stays, higher costs, and lower discharge likelihood.⁹ However, data on ventricular aneurysms post-MINOCA are lacking. With improvements in MINOCA diagnosis and growing professional interest, we anticipate more knowledge and experience on MINOCA and its complications.

Informed Consent: Informed consent was obtained from all individual participants included in the study.

Authorship Contributions: Concept- C.Ö., G.T.; Design- C.Ö., G.T.; Supervision- C.Ö., G.T., F.E.U.; Fundings- C.Ö., G.T., F.E.U.; Materials- C.Ö., G.T., F.E.U., T.E.; Data Collection or Processing- C.Ö., G.T., F.E.U., T.E.; Analysis or Interpretation- C.Ö., G.T., F.E.U., T.E.; Literature Search- C.Ö., G.T., F.E.U., T.E.; Writing- C.Ö., G.T., F.E.U., T.E.; Critical Review- C.Ö., G.T., F.E.U., T.E.

Conflict of Interest: No conflict of interest was declared by the authors.

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