Rapid Development of a Giant Left Ventricular Aneurysm After Delayed Percutaneous Coronary Reperfusion for Acute Myocardial Infarction

Abstract

A71-year-old woman underwent stenting of the circumflex artery with a noncoated stent 9 hours after the initial symptoms of an acute lateral myocardial infarction with thrombolysis in myocardial infarction (TIMI) II results for a single-vessel disease. She left the hospital after 5 days with an ejection fraction of 50%, akinesia of the posterolateral wall and mild mitral regurgitation. She was treated for 10 days with a nonsteroidal anti-inflammatory drug for Dressler's syndrome. Fifty-two days later she presented with mild excertional dyspnea and back discomfort. The transthoracic echocardiogram demonstrated an ejection fraction of 30%, severe mitral regurgitation, and a large (5 cm) left ventricular lateral wall false or true aneurysm. The magnetic resonance imaging showed a large (5 × 7 cm) posterolateral aneurysm (Fig 1,arrow) with a wide connection (Fig 1, asterisk) to the left ventricular cavity without viability and severe mitral regurgitation by balanced gradient echocardiographic sequence through the left ventricle. The patient underwent mitral valve replacement by a ventricular approach (Fig 2) through the aneurysmal cavity (Fig 2A, arrow) and a true aneurysm repair (Fig 2B) by a modified Dor procedure. Pathologic examination revealed an occluded coronary artery and a true aneurysm containing myocardial cells.Fig 2View Large Image Figure ViewerDownload (PPT) A71-year-old woman underwent stenting of the circumflex artery with a noncoated stent 9 hours after the initial symptoms of an acute lateral myocardial infarction with thrombolysis in myocardial infarction (TIMI) II results for a single-vessel disease. She left the hospital after 5 days with an ejection fraction of 50%, akinesia of the posterolateral wall and mild mitral regurgitation. She was treated for 10 days with a nonsteroidal anti-inflammatory drug for Dressler's syndrome. Fifty-two days later she presented with mild excertional dyspnea and back discomfort. The transthoracic echocardiogram demonstrated an ejection fraction of 30%, severe mitral regurgitation, and a large (5 cm) left ventricular lateral wall false or true aneurysm. The magnetic resonance imaging showed a large (5 × 7 cm) posterolateral aneurysm (Fig 1,arrow) with a wide connection (Fig 1, asterisk) to the left ventricular cavity without viability and severe mitral regurgitation by balanced gradient echocardiographic sequence through the left ventricle. The patient underwent mitral valve replacement by a ventricular approach (Fig 2) through the aneurysmal cavity (Fig 2A, arrow) and a true aneurysm repair (Fig 2B) by a modified Dor procedure. Pathologic examination revealed an occluded coronary artery and a true aneurysm containing myocardial cells.