A massive calcified left ventricular aneurysm

Abstract

A 60-year-old woman presented with chest pain and dyspnea, and her medical history included an anterior myocardial infarction eight years earlier. An electrocardiogram revealed ST-segment elevation with associated Q-waves in the V1, V2, II, III and aVF leads. The transthoracic echocardiography showed a hyper-reflective calcified apical aneurysm. The patient’s end diastolic volume was 186 mL, and she had an ejection fraction of 38%. Subsequent coronary angiography revealed a total occlusion of the left anterior descending artery and the midportion of the right coronary artery as well as critical stenosis of the circumflex coronary artery. A oval-shaped calcified structure that resembled a calcified apical left ventricular aneurysm was observed during the left main artery (Figure 1a) and right coronary artery injections (Figure 1b). The patient then underwent an uneventful quadruple myocardial revascularization operation that included the resection of the calcified aneurysm (Figure 2a) and the reconstruction of the left ventricular wall via endoventricular patch plasty, which was previously described by Cooley.[1] The excised tissue was identified as a massive, calcified, semi-oval sphere measuring 4.5x4 cm (Figure 2b).