Giant Left Ventricular Aneurysm Research Articles

Giant Left Ventricular Aneurysm With Dynamic Right Ventricular Compression and Subsequent End-Stage Heart Failure

We report a case of a patient with a missed anterior myocardial infarction and associated ischemic cardiomyopathy. The patient had a massive true left ventricular aneurysm causing dynamic right ventricular compression, with associated cardiogenic shock, for which a heart transplantation was ultimately performed.

A Rare Combination of Mechanical Complications Following Myocardial Infarction: Ventricular Septal Rupture and an Extensive Ventricular Aneurysm

Mechanical complications following acute myocardial infarction (MI) are rare and account for <1% of the total cases, with the advent of the newest revascularization methods. Although this low incidence, the mortality rate is high, especially among older patients. A 51 years old female, with a history of diabetes and asthma, was admitted to our cardiac intensive care unit for heart failure symptoms. She was diagnosed about 3 weeks ago, with acute anterior wall MI. She did not undergo any revascularization because of the lack of means and was on optimal medical therapy. Transthoracic echocardiography (TTE) revealed akinesia of the inferior, septal, and lateral wall, and all apical segments with a giant aneurysm of 10mm, and a posterior interventricular rupture with a left-right shunt, with a reduced left ventricular (LV) ejection fraction of 19%. An enhanced computed tomography (CT) scan revealed a ventricular septal (VS) defect with a giant left ventricular aneurysm (LVA), which was connected to the LV posterior wall. Urgent cardiac surgery after a percutaneous cardiac intervention was not realized because of lack of means. The association of VS rupture and LVA, found in our patient, is an extremely rare and highly lethal complication requiring urgent surgical management. Its incidence is between 1% and 2% of MIs. TTE has very high sensitivity and specificity, to provide diagnosis and evaluation of VS rupture and LVA. Color-flow Doppler identifies abnormal flow within the aneurysm and helps to highlight ventricular ruptures as an additional image in the endocardium. CT is fast, provides a clear resolution of the LV, and may be used to demonstrate the complications of infarction. The management of VSD is surgical, with the difficulty of repair from fragile infarcted tissue. Medical therapy should stabilize the hemodynamics and act as a bridge to surgery. The simultaneous presence of a VS rupture and LVA is rare and usually occurs within the MI. However, as shown in ..

Giant postinfarction posterolateral left ventricular aneurysm, complicated by mitral insufficiency

Ischemic heart disease holds the leading position in the structure of cardiovascular diseases. Early reperfusion therapy for acute myocardial infarction led to a decrease in mortality and severe complications of coronary artery disease. Despite advances in the treatment of coronary artery disease, dilatation and remodeling of the left ventricle develop in 20% of patients who have had a heart attack, leading to mitral insufficiency and systolic dysfunction of the left ventricle. Aneurysm of the left ventricle is a delayed severe complication of myocardial infarction, which significantly worsens the prognosis. Large aneurysms of the left ventricle cause progressive dilatation of the left ventricle, its volumetric overload with an increase in wall tension in the non-infarction zone, decreased functional characteristics of the left ventricle, thrombosis in the aneurysm cavity, life-threatening arrhythmias, and sudden death. Postinfarction left ventricular remodeling can lead to secondary mitral regurgitation, which is an independent predictor of mortality in the longterm period. Surgical treatment of coronary heart disease and its complications is one of the main problems of modern cardiovascular surgery.

Giant left ventricular aneurysm following arterial switch operation.

Giant left ventricular aneurysm following arterial switch operation.

A CASE OF SUCCESSFUL SURGICAL TREATMENT OF CORONARY ARTERY DISEASE WITH COMPLICATED POSTINFARCTION LEFT VENTRICULAR ANEURYSM

Abstract: Left ventricular aneurysms (LV aneurysms) are a common complication of acute myocardial infarction, in which the scar area of the left ventricular tissue gradually becomes thinner and dyskinetic. The aneurysm often consumes some of the left ventricular ejection, which ultimately leads to chronic heart failure, which may be refractory to drug therapy and require surgical repair with apical left ventricular aneurysm. Surgical techniques to restore the volume and shape of the left ventricle have evolved over the years. Surgical treatment of LV aneurysms was first performed by Charles Bailey [1]. Denton Cooley and colleagues [2] reported about the first resection in cardiopulmonary bypass. Over the next decades, in addition to traditional linear plastics, new methods of patch remodeling were developed and published in order to improve the results [3,6]. Although aneurysmectomy has been performed for almost five decades, the most appropriate surgical approach for a patient with LV dyskinetic aneurysm is still controversial. Myocardial ischemia leads to the loss of a part of the viable myocardium and causes a whole complex of morphological and functional disorders of the heart. The latter, as a rule, are based on the processes of cicatricial transformation of the left ventricular myocardium, leading to disproportionate stretching and thinning of its walls, dilatation and spherization of its cavity, which in turn is the cause of pathological changes in intraventricular spatial-geometric relationships, which together define the concept ischemic remodeling. The formation of a left ventricular aneurysm often occurs with acute occlusion of the LAD, which leads to the development of severe angina pectoris and a clinic of severe heart failure. Plasty of the left ventricular aneurysm according to Dor and modified by Academician L.A. Bokeria - circular narrowing of the orifice of the aneurysmal sac and endoventriculoplasty of the left ventricle with a synthetic patch, in postinfarction LV aneurysms, has proven its safety and effectiveness. This operation is devoid of the disadvantages inherent in other methods of left ventricular reconstruction. It allows for a complete resection of the aneurysm with minimal risk of critical reduction of the LV cavity. Reconstruction of the left ventricular aneurysm and myocardial revascularization leads to a significant improvement in pumping function and a decrease in symptoms of heart failure. As a clinical example, a case of successful surgical treatment of a giant left ventricular aneurysm is presented.

Multimodal imaging of a giant left ventricular basal aneurysm and resulting intracardiac flow disturbances.

Multimodal imaging of a giant left ventricular basal aneurysm and resulting intracardiac flow disturbances.

Volumineux faux anévrisme de la pointe du ventricule gauche révélant un infarctus du myocarde silencieux

Left ventricular false aneurysms are rare. They are secondary to a myocardial rupture which is contained by adherent pericardium and scar tissue. LV pseudoaneurysm contains no endocardium or myocardium unlike left ventricular true aneurysm. Most cases of LV pseudoaneurysm are related to acute myocardial infarction in inferior or posterior wall. We report a case of a 56-year-old man with a medical history of chronic cigarette smoking, dyslipidemia, and obesity. The patient had no myocardial infarction before. He was admitted for evaluation of important shortness of breath at effort without chest pain for 5 months. Physical exam find an enlarged left ventricular. The electrocardiogram revealed Q waves and ST segment elevation in leads V1 to V6. Transthoracic echocardiogram showed a large thrombosed apical left ventricular false aneurysm, severe left ventricular dysfunction, which were confirmed by cardiac magnetic resonance imaging, this exam also showed no viability in the mid left anterior descending coronary artery territory. The coronary angiography showed an occlusion of the mid left anterior descending coronary artery and a stenosis of the first diagonal artery. The patient was offered a surgical aneurysectomy with coronary artery bypass. The surgery was successful with amelioration of symptoms. We present a rare case of a giant false left ventricular aneurysm complicating a silent myocardial infarction in the anterior wall. The diagnosis is made by cardiac echocardiogram and cardiac magnetic resonance imaging. Because of the important risk of rupture, the surgical treatment is required.

P871 Giant left ventricular (pseudo?)aneurysm complicating anterior myocardial infarction

Abstract Introduction Clinical approach of cardiac aneurysms and pseudoaneurysms is significantly distinct. Therefore, it is crucial to accurately differentiate these two entities, which could be a real challenge. Case report We describe a case of a 55-year-old woman, with hypertension and previous smoking habits. She was admitted in our Cardiology Department with the diagnosis of anterior acute myocardial infarction, and was submitted to emergent coronariography, unveiling an occlusion of the middle segment of the anterior descending artery. She underwent successful primary percutaneous coronary intervention (PCI) 1h45 after the chest pain onset. Transthoracic echocardiogram (TTE) revealed depressed left ventricle ejection fraction (LVEF 30%), with akinesia of anterior and septal walls and all apical segments. She evolved in Killip-Kimbal class 2 and was discharged clinically stable. One week later, the patient performed a control TTE that showed an apical thrombus, with a small pericardial effusion, and she initiated warfarin. Three weeks later, a reevaluation TTE demonstrated a severe increase of the left ventricle dimensions, with LVEF 32%, and a small pericardial effusion. In apical 4-chambers incidence, it was visualized a linear structure (42 mm x 5 mm) attached to the endocardial border of the anterolateral apical segment and to the apical segment of the interventricular septum, of undefined nature. The apical segments were dyskinetic and had a very thin wall, which could correspond to aneurysm versus pseudoaneurysm. To clarify these findings, the patient performed a cardiac magnetic resonance revealing a large anterior myocardial infarction complicated with extensive myocardial necrosis, severe depression of LV systolic function (LVEF 25%) and septum rupture distal to the right ventricle apex (without connecting with it), compatible with a large apical pseudoaneurysm. The clinical case was discussed in the Heart Team and it was decided to perform cardiac surgery. However, surgical findings showed integrity of septal and free walls, and she underwent an aneurysmectomy, without further complications. Histological examination confirmed the presence of a thin myocardial wall with marked fibrosis and, consequently, the diagnosis of ventricular aneurysm. She was discharged clinically stable and maintains follow-up in Cardiology consultation of our Hospital. Conclusion In this patient, initially admitted with an anterior myocardial infarction submitted to primary PCI, follow-up with advanced imaging modalities pointed to the diagnosis of pseudoaneurysm. Despite the preoperative diagnosis, surgical findings were compatible with a giant left ventricular aneurysm. Even with high spatial resolution exams, postoperative evaluation of tissue layers remains the gold standard for this differential diagnosis. Abstract P871 Figure. Apical pseudoaneurysm vs aneurysm

Successful Surgical Treatment of a Giant Left Ventricular Aneurysm

Left ventricular anevrysm (LVA) is the effect of left ventricular (LV) remodeling after myocardial infarction (MI). The surgical technique to improve cardiac function is geometric reconstruction of the LV. The aim of this paper is to highlight the importance of restoring left ventricle geometry. We report a case of 53 year-old man, without any known cardiovascular history, with acute anterior myocardial infarction, left ventricular aneurysm and massive left ventricular thrombus, who arrived into the emergency department 24 hours after the onset of symptomatology. After hemodynamic stabilization, we performed geometric reconstruction of the left ventricle. With favorable postoperative evolution, patient is discharged 14 days later. At the periodic checkups it is noted that he�s postoperative ejection fraction (EF) improved and also the quality of life.

The Successful Surgical Treatment of a Giant True Left Ventricular Aneurysm: a Case Report

We report the successful surgical treatment of a giant true thrombosed aneurysm of the left ventricle.A 59-year-old male patient Z. was admitted with severe heart failure and chronic thrombosed aneurysm of the left ventricle, formed after acute extensive myocardial infarction, despite successful installation of a stent into the anterior descending artery in the acute period. Echocardiography revealed a significant increase in the volume of the left ventricular cavity, a significant decrease in the contractile function of the left ventricular myocardium (ejection fraction 32-36%), a giant left ventricular aneurysm (9x6 cm) with a parietal lining thrombus in the aneurysm cavity. Coronary angiography showed an aneurysmal dilatation of the circumflex branch of more than 6 mm, hemodynamically significant stenosis of two coronary arteries. According to the scintigraphy, the myocardium beyond the scar tissue was viable. The patient underwent resection of a left ventricular aneurysm, endoventricular plasty (Dor procedure), coronary artery bypass surgery of the circumflex artery and obtuse marginal branch of the left coronary artery.The patient was discharged in satisfactory condition on day 14 after surgery. At follow-up 6 months after surgery, an increase in the ejection fraction to 3941% was noted.

A case of cardiac sarcoidosis accompanied with giant left ventricular aneurysm diagnosed by anterior mediastinal lymph node biopsy during open heart surgical procedure

A case of cardiac sarcoidosis accompanied with giant left ventricular aneurysm diagnosed by anterior mediastinal lymph node biopsy during open heart surgical procedure

Left ventricular noncompaction (LVNC) with giant left ventricular aneurysm detected by multi detector computed tomography angiography

Left ventricular noncompaction (LVNC) is a rare form of cardiomyopathy caused by the failure of myocardial compaction during embryogenesis. Clinical features spectrums from are from being totally asymptomatic to systolic dysfunction, heart failure (HF), tachyarrhythmias, and systemic thromboembolism. However, there have been only few reports regarding its coexistence with LV aneurysm. A 34-year-old man with no significant cardiopulmonary history was evaluated for progressive exertional dyspnoea. The chest radiography exhibited cardiomegaly, mild pulmonary congestion and huge calcified shadow at apex. The laboratory data was unremarkable except for elevated brain-type natriuretic peptide. Transrthoracic echocardiography demonstrated global hypokinesia with an ejection fraction of 30%, prominent trabeculation and deep intertrabecular recesses, and calcified aneurysm (12.3x7.8 cm), and increased noncompacted (NC) endomyocardial layer depth compared to the compacted (C) epicardial layer (NC/C= 2.4) which was further confirmed on multi detector computed tomography (MDCT). Based on these findings, he was diagnosed as LVNC complicated with a giant calcified aneurysm. He was discharged with carvedilol, ramipril, and frusemide and referred for surgical restoration/resection of aneurysm. Here, to the best of our knowledge, we report the patient who had LVNC with biggest LV aneurysm.

Giant Left Ventricular Outflow Tract Aneurysm Presenting as Unstable Angina: An Unusual Case

Giant Left Ventricular Outflow Tract Aneurysm Presenting as Unstable Angina: An Unusual Case

Giant true inferoposterior left ventricular aneurysm presenting with heart failure: insights from multimodality imaging

A 58-year old male patient who had undergone post-infarction ventricular septal defect closure and venous coronary bypass grafting to the obtuse marginal artery 2 years previously, presented with congestive heart failure. Echocardiography, computed tomography and ventriculography revealed a giant inferoposterior left ventricular aneurysm (Fig. 1A–D, Supplementary Video 1). Surgical left ventricular restoration was performed by a direct linear suture (Fig. 1E and F).

An Extraordinary Case of Silent Extensive Anterior Wall Myocardial Infarction Complicated with Giant Left Ventricular Aneurysm and Dressler Syndrome

Early post-acute myocardial infarction (AMI) pericarditis, pericardial effusion with or without cardiac tamponade, and late post-MI pericarditis (Dressler syndrome), are the major pericardial complications after AMI. It is quite rare and estimated to be only about 0.1% in AMI patients according to a recent report, so it is easily neglected or misdiagnosed and may have tragic result to patient. Clinical features of this post-AMI complication include fever, chest pain, pericarditis and pleurisy occurring 2 to 3 weeks after AMI. Dressler syndrome is rarely associated with left ventricular aneurysm. Contrast enhanced magnetic resonance and echocardiography play important roles in diagnosis of left ventricle aneurysm. We report a 54-year-old male heavy labor worker who had asymptomatic, severe coronary artery disease, complicated with silent myocardial infarction, which resulted in large left ventricular aneurysm, and also systolic heart failure was noted. Patient was diagnosed to have Dressler syndrome after his second cardiology clinic follow-up. He received coronary angiography which revealed triple vessel disease with total occlusion of left anterior descending artery, and a giant left ventricular aneurysm was found. He received surgical intervention with Batista method and followed-up uneventfully at the cardiology clinic.

Giant lateral left ventricular wall aneurysm sparing the submitral apparatus

Left ventricular aneurysms are a frequent and serious complication following acute transmural myocardial infarction and are most commonly located at the ventricular apex. The majority of these patients presents with severe mitral insufficiency, congestive heart failure, systemic embolism and sudden cardiac death. Giant aneurysms occurring in a submitral position between anterior and posterior papillary muscles on the lateral ventricular wall constitute a minor entity and those leaving the mitral apparatus intact are extremely rare.Herein, we report the case of a 57 y/o Caucasian male patient with a past medical history of coronary artery disease and myocardial infarction with a giant left ventricular aneurysm measuring 15x10x8 cm in diameter. Despite the size of the aneurysm and its close topographical relation to the posterior mitral annulus the mitral apparatus was intact with a competent valve and normal left atrial size. He underwent successful surgical ventricular restoration.

Giant left ventricular aneurysm as a late complication of inferior myocardial infarction

After 3 days of nausea and dyspnoea, a 62-year-old man was found to have a completed inferior myocardial infarction. Angiography demonstrated right coronary artery occlusion, and no intervention was performed. Several days later, he had worsened dyspnoea and syncope due to pericardial haematoma. This prompted emergent surgical evacuation and patch repair of a 2-cm inferior wall rupture. Three months later, he presented …

Giant Posterolateral Left Ventricular Aneurysm Diagnosed 6 Weeks After Incomplete Surgical Revascularization

We report the surgical repair of a true left ventricular aneurysm diagnosed 6 weeks after incomplete surgical revascularization.

Successful Surgical Repair of a Giant Calcified Left Ventricular Aneurysm: A Report of a Case

A 68-year-old man presented at the outpatient clinic with epigastric discomfort. He had suffered a myocardial infarction 10 years previously. Chest radiography and computed tomography showed a giant calcified aneurysm in the left ventricle. Electrocardiography indicated atrial fibrillation. Echocardiography showed moderate mitral regurgitation and enlarged left atrium. End-diastolic volume and ejection fraction were 164 ml and 31%, respectively. Coronary angiography revealed total occlusion of the left anterior descending artery and diffuse stenosis of the right coronary artery. Aneurysmectomy, mitral annuloplasty, maze procedure, and coronary artery bypass were performed. The patient was discharged 16 days postoperatively in a satisfactory condition without complications.

Successful surgical restoration of a giant immature left ventricular aneurysm with computer assisted ventricle engineering

Abstract Background: Although circular ventricle resection techniques are the gold standard of left ventricle restoration, these techniques can lead to suboptimal results. Postoperative systolic resection line can be inadequate, as it must be planned on a heart stopped in diastole. The impaired geometry and contractility may lead to increased short- and long-term mortality. Moreover, postoperative low cardiac output due to insufficient left ventricular volume results in a potentially unstable condition, and cannot be corrected. Our aim was to find a preoperative method to minimize risk and maximize outcome with left ventricle restoration. Methods: We have created a novel method combining surgery with modern imaging techniques to construct a preoperative 3D systolic heart model. The model was utilized to determine resection could be intraoperatively used to create the new left ventricle. Results: The computer assisted ventricle engineering technique is described step by step through a successful aneurysmectomy of a 61-year-old female patient with a complicated giant left ventricle aneurysm. Conclusions: Using this model we are able to find the optimal resection line providing excellent postoperative result, thus minimizing the risk of low cardiac output syndrome. This is the first report of our new combined approach to left ventricle restoration.