Left Ventricular Aneurysm and Thromboembolization

Abstract

To the Editor:To emphasize the important topic discussed by Cabin and Roberts in their recent article entitled “Left Ventricular Aneurysm, Intra-aneurysmal Thrombus and Systemic Embolus in Coronary Heart Disease” (Chest 1980; 77:586-90), we would like to report the following case.CASE ReportA 63-year-old retired college professor was seen in October, 1979 with a history of recent episodes of confusion and amaurosis fugax. Extracranial angiography demonstrated embolic occlusion of the mid-portion of the ophthalmic artery and right posterior cerebral artery. He was maintained on anticoagulant therapy but had another episode of confusion and amnesia lasting several hours. In 1967 the patient had an acute anteroseptal myocardial infarction without antecedent history of coronary artery disease. Twelve years later, in 1979, the patient had some exertional chest pain which led to cardiac catheterization. Cardiac catheterization showed a large left ventricular apical aneurysm with eggshell calcification and an intraluminal filling defect attributed to thrombus. The coronary arteries were free of any significant lesions, including the left anterior descending coronary artery supplying the area of the aneurysm. Because of the patient's history and evidence for repeated embolic episodes, including one episode while on anticoagulation, surgical repair of his aneurysm was recommended. At operation, the aneurysm was repaired with cardiopulmonary bypass. There was thrombus within the cavity of the aneurysm, and the thrombus was shaggy. He made an uneventful recovery from surgery and has had no further neurologic episodes since resection of his left ventricular aneurysm and removal of the thrombus.DISCUSSIONThis patient represents an example of acute myocardial infarction followed by development of a left ventricular aneurysm with thrombus and arterial embolization 12 years later in a patient with essentially normal coronary arteries. To the Editor: To emphasize the important topic discussed by Cabin and Roberts in their recent article entitled “Left Ventricular Aneurysm, Intra-aneurysmal Thrombus and Systemic Embolus in Coronary Heart Disease” (Chest 1980; 77:586-90), we would like to report the following case. CASE ReportA 63-year-old retired college professor was seen in October, 1979 with a history of recent episodes of confusion and amaurosis fugax. Extracranial angiography demonstrated embolic occlusion of the mid-portion of the ophthalmic artery and right posterior cerebral artery. He was maintained on anticoagulant therapy but had another episode of confusion and amnesia lasting several hours. In 1967 the patient had an acute anteroseptal myocardial infarction without antecedent history of coronary artery disease. Twelve years later, in 1979, the patient had some exertional chest pain which led to cardiac catheterization. Cardiac catheterization showed a large left ventricular apical aneurysm with eggshell calcification and an intraluminal filling defect attributed to thrombus. The coronary arteries were free of any significant lesions, including the left anterior descending coronary artery supplying the area of the aneurysm. Because of the patient's history and evidence for repeated embolic episodes, including one episode while on anticoagulation, surgical repair of his aneurysm was recommended. At operation, the aneurysm was repaired with cardiopulmonary bypass. There was thrombus within the cavity of the aneurysm, and the thrombus was shaggy. He made an uneventful recovery from surgery and has had no further neurologic episodes since resection of his left ventricular aneurysm and removal of the thrombus. A 63-year-old retired college professor was seen in October, 1979 with a history of recent episodes of confusion and amaurosis fugax. Extracranial angiography demonstrated embolic occlusion of the mid-portion of the ophthalmic artery and right posterior cerebral artery. He was maintained on anticoagulant therapy but had another episode of confusion and amnesia lasting several hours. In 1967 the patient had an acute anteroseptal myocardial infarction without antecedent history of coronary artery disease. Twelve years later, in 1979, the patient had some exertional chest pain which led to cardiac catheterization. Cardiac catheterization showed a large left ventricular apical aneurysm with eggshell calcification and an intraluminal filling defect attributed to thrombus. The coronary arteries were free of any significant lesions, including the left anterior descending coronary artery supplying the area of the aneurysm. Because of the patient's history and evidence for repeated embolic episodes, including one episode while on anticoagulation, surgical repair of his aneurysm was recommended. At operation, the aneurysm was repaired with cardiopulmonary bypass. There was thrombus within the cavity of the aneurysm, and the thrombus was shaggy. He made an uneventful recovery from surgery and has had no further neurologic episodes since resection of his left ventricular aneurysm and removal of the thrombus. DISCUSSIONThis patient represents an example of acute myocardial infarction followed by development of a left ventricular aneurysm with thrombus and arterial embolization 12 years later in a patient with essentially normal coronary arteries. This patient represents an example of acute myocardial infarction followed by development of a left ventricular aneurysm with thrombus and arterial embolization 12 years later in a patient with essentially normal coronary arteries.