Submitral left ventricular aneurysms: Anesthetic considerations

Abstract

S UBMITRAL aneurysms occur in the left ventricle adjacent to the mltral annulus. They are the most common subannular aneurysms of the left ventricle. The aneurysms are often large and multiloculated and contain thrombi. They tend to grow into the pericardial space, behind the left atrium, bulging through its floor) A significant segment of the posterior mitral annulus is involved that leads to loss of support for the posterior leaflet with prolapse and consequent regurgitation 2 It may also compress the circumflex coronary artery, leading to angina pectoris or myocardial infarction. Submitral aneurysms are not uncommon in the black population of Africa, and occasional cases have been described m the white population outside of Africa. 2-6 They have also been reported in the Indmn population. 7 The incidence of this condmon is 1% to 2% of isolated mitral valve disease in the African population as reported by Antunes. I The cause is unknown but appears to be related to a defect or developmental weakness between the muscular ventricular wall and the fibrous annulus. The hemodynamlc impairment is related to the systolic expansion of the aneurysm, to valve regurgitation, or to both. The symptoms are those of congestive heart failure and angina pectorls. Occasionally they rupture, s Reported is an experience with two such patients and highlighted are the assocmted problems that might influence the successful anesthetic management of such patients. The authors believe this to be the first report describing the anesthetic management of such cases. A case of grant submitral aneurysm was reported about 6 years ago. 7 The patient died of low cardiac output syndrome after surgery However, the patient is not included in this report due to the unavailability of the anesthetic details.