Left Ventricular Apical Aneurysm Research Articles

Electrocardiographic evolution in patients with hypertrophic cardiomyopathy who develop a left ventricular apical aneurysm

IntroductionHypertrophic cardiomyopathy (HCM) patients with apical aneurysm have a largely unfavourable clinical course, and are often unrecognised because echocardiography is limited in the assessment of the left ventricular (LV) apex. The aim of this study is the identification of electrocardiographic (ECG) abnormalities associated with the development of apical aneurysm in HCM patients. Materials and methodsElectrocardiographic features were assessed in 14 HCM patients who had a good-quality baseline ECG recorded before and after the diagnosis of apical aneurysm. ResultsDuring follow-up (8.8±7.5years), the following ECG changes were observed: increase in QRS-complex duration (87±12ms to 118±34ms, p=0.006), QRS-complex fragmentation, decrease in QRS-complex amplitude (SV1+RV5-6, from 41±18mm to 26±11mm, p=0.015), ST-segment elevation in V4–V6 (J-point in V5, from −0.9±1.3mm to +0.7±1.3, p=0.003), positivisation of negative T waves in V3-V6 (T-wave depth in V5, from −3.4±6.6 to +3.1±4.1, p=0.005). ConclusionsHCM patients who develop LV apical aneurysm exhibit distinctive ECG changes along with apical remodelling. Suggestive ECGs should lead the physician to study LV apex by nonstandard echocardiographic views, and perform MRI.

A Rare Cause of Severe Flank Pain : Renal Infarction

Renal infarction is a common clinical problem and often misdiagnosed because the symptoms are subtle. We are presented our patient who applicant with left flank pain and diagnosed renal infarction. 49-year-old male patient has come with 2 days of severe left flank. Pathologic were; left costovertebral angle tenderness, creatinine: 1.3 mg/dL, C reactive protein: 11.4 mg/dL. On Computed Tomography Angiography renal arteries there was no contrast matter transmission to left arcuat artery distale and there were ischemic regions. With renal infarction diagnose, patient was hospitalized. Organized thrombosis seen inside apical left ventricular aneurysm with transesophageal ecocardiography Patient was discharged from hospital with plannings of policlinic controls for INR follow-ups. We want to emphasize that it should be kept in mind that the diagnosis of renal infarction in the clinical management of patients with flank pain.

Abstract 13943: Hypertrophic Cardiomyopathy with Left Ventricular Apical Aneurysm Represents a High-Risk Subgroup Necessitating Aggressive Preventive Therapy: A Long-term Follow-Up Study

Background: Increasing penetration of high spatial resolution cardiovascular magnetic resonance (CMR) imaging into routine cardiovascular practice has resulted in more frequent identification of a subset of hypertrophic cardiomyopathy (HCM) patients with thin-walled, scarred left ventricular (LV) apical aneurysms. Prior experience involved relatively small numbers of patients with short follow-up and therefore the risk associated with this subgroup remains incompletely defined. Therefore, we assembled a large HCM cohort with LV apical aneurysms and long-term follow-up in order to clarify clinical course and prognosis. Methods and Results: Of 2,400 HCM patients, 60 (2.5%) were identified by CMR with LV apical aneurysm, 24 to 86 years of age, including 19 (32%) <45 years old; 70% male, and followed for 5.6 ± 3.5 years. Over the follow-up period, 24 patients experienced 31 adverse disease-related complications including: appropriate implantable cardioverter-defibrillator discharge for VT/VF (n=11), received or listed for heart transplant (n=6), heart failure death (n=5), nonfatal thromboembolic events (n=4), resuscitated out-of-hospital cardiac arrest (n=3), and sudden death (n=2). In addition, an intracavitary thrombus was identified in the apical aneurysm in 9 patients without a thromboembolic history. Combined HCM-related death and aborted life threatening event rate was 8.6% per year, nearly 6-fold greater than the 1.5% annual mortality rate reported in the general HCM population. Conclusions: Patients with LV apical aneurysms represent a high-risk subgroup within the diverse HCM spectrum, associated with substantial increased risk for disease-related morbidity and mortality, including advanced heart failure, thromboembolic stroke and sudden death. Identification of this unique HCM phenotype should prompt consideration for primary prevention ICD, and anticoagulation for stroke prophylaxis.

A massive calcified left ventricular aneurysm

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).

Left ventricular apical aneurysm in chronic Chagas cardiomyopathy—A case report

A 56-year-old female, who immigrated to the USA from Honduras, presented with worsening shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and decreased exercise tolerance over the previous 2 months. She was diagnosed 1 year previously with non-ischemic dilated cardiomyopathy and non-sustained monomorphic ventricular tachycardia. An implantable cardioverter defibrillator was placed. Cause for her dilated cardiomyopathy was unknown at that time. On admission, her electrocardiogram showed low voltage complexes, with frequent premature ventricular contractions. Transthoracic two-dimensional echocardiogram (2D ECHO) showed severely reduced ejection fraction of 20%, severe mitral regurgitation with left ventricular (LV) hypokinesis, and inferolateral and inferior wall akinesis. On review of her records, a contrast 2D ECHO from the previous year revealed an aneurysm of the LV apical region. Live three-dimensional (3D) ECHO on her present admission showed persistent LV apical aneurysm. Computed tomography angiogram showed no atherosclerotic lesions. Multiple episodes of non-sustained ventricular tachycardia were recorded on telemetry. Based on these findings, the diagnosis of Chagas cardiomyopathy was entertained. Serological tests for Trypanosoma cruzi antibodies were done and returned positive. We report a case of chronic Chagas cardiomyopathy that was initially missed but ultimately diagnosed based on the finding of LV apical aneurysm.<Learning objective: Chagas cardiomyopathy is becoming increasingly prevalent in non-endemic countries. One hallmark finding associated with Chagas cardiomyopathy is left ventricle apical aneurysm. We were able to identify this finding with transthoracic contrast 2D ECHO and live 3D ECHO.>

Clinical significance of left ventricular apical aneurysms in hypertrophic cardiomyopathy patients: The role of diagnostic electrocardiography

ObjectivesSome patients with hypertrophic cardiomyopathy (HCM) develop left ventricular apical aneurysm, leading to serious cardiovascular complications. The aims of this study were to identify the incidence and clinical course of HCM patients with apical aneurysms in Japan, and to evaluate the role of electrocardiography (ECG) as a screening test to detect apical aneurysms in HCM patients. Methods and resultsIn a retrospective, single center analysis of a population of 247 HCM patients, 21 patients (8.5%) had left ventricular apical aneurysms. Their mean age was 60±14 years (range: 23–77 years) at study entry. Over 4.7±3.3 years of follow-up, 10 patients (47.6%) experienced an adverse clinical event (annual event rate: 10.1%/y), including five implantable cardioverter-defibrillator (ICD) implantations for ventricular tachycardia/ventricular fibrillation (VT/VF), an appropriate discharge of ICD for VT/VF, and four nonfatal thromboembolic strokes. Two patients developed systolic dysfunction (ejection fraction <50%). No sudden cardiac death or progressive heart failure was detected. Fourteen patients showed ST-segment elevation (≥1mm) in V3 through V5 of ECG. In four patients, progression of the ST-segment elevation was recognized. When the ST-segment elevation was used to identify apical aneurysms in HCM patients, the sensitivity was 66.7%, and the specificity was 98.7%. ConclusionApical aneurysms in HCM patients in Japan are not rare, and are associated with serious cardiovascular complications. The early diagnosis of apical aneurysms can be achieved by serial ECG.

Left ventricle pseudoaneurysm as late postoperative complication of a large apical aneurysm

We report here the case of a patient with large left ventricular apical aneurysm incidentally discovered seven years after an inferior myocardial infarction. The aneurysm was successfully corrected by surgery. However, five months after surgery, the patient’s evolution was complicated by the sudden occurrence of a pseudoaneurysm. This case is complex and interesting because of several factors, including the incidental discovery, the atypical localization of an aneurysm secondary to the right coronary chronic occlusion, the size of the aneurysm, the preoperative differential diagnosis and the unusual late postoperative evolution.

Left ventricular apical aneurysm: a novel phenotype of Fabry's disease

A 63-year-old man with a history of chronic kidney disease and atrial flutter status post ablation and permanent pacemaker implant presented with worsening shortness of breath. Echocardiogram revealed asymmetric left ventricular wall thickness involving the posterior wall and midventricular …

Ventricular tachycardia in hypertrophic cardiomyopathy with apical aneurysm successfully treated with left ventricular aneurysmectomy and cryoablation

A 64-year-old woman with type II diabetes mellitus was admitted to our institution with incessant ventricular tachycardia. She reverted to sinus rhythm after treatment with intravenous amiodarone, but the tachyarrhythmia recurred days later. Coronary angiography showed unobstructed coronary arteries. Left ventriculography ( Panel A , Supplementary material online, Video S1 ) revealed apical ballooning with mid-ventricular obstruction, suggestive of either large left ventricular (LV) apical aneurysm or stress (Takotsubo) cardiomyopathy. Transthoracic …

Apical left ventricular false aneurysm after transapical transcatheter aortic valve implantation

Transcatheter valve implantation (TAVI) is becoming a routine procedure to treat severe symptomatic aortic stenosis. It is associated with complications different from those of conventional aortic valve surgery. We describe an 80-year old man who developed an apical left ventricular (LV) false aneurysm 3 months after transapical TAVI (TA-TAVI) complicated postoperatively by a surgical site infection (SSI). Three months earlier, an Edwards Sapien bioprosthesis no. 29 had been successfully inserted transapically because of severe comorbidities and a very large aortic annulus. His postoperative course was complicated by acute respiratory failure, gastrointestinal bleeding and a surgical site infection of the thoracic incision; Escherichia coli and Klebsiella pneumonia were isolated. After surgical debridement drainage and prolonged antibiotic therapy, the wound healed correctly. His emergency chest computed tomography upon readmission for the acute onset of a beating tumefaction at the TA-TAVI site showed a false aneurysm of the LV apex. The apex was closed directly during emergency surgery. The postoperative course was uneventful. Surgical site infection after TA-TAVI, its frequency, treatment and potential role as an underlying cause of this severe complication are discussed.

Electrocardiographic features and clinical course of patients with hypertrophic cardiomyopathy and left ventricular apical aneurysm

Electrocardiographic features and clinical course of patients with hypertrophic cardiomyopathy and left ventricular apical aneurysm

Aneurysm associated with normal coronary arteries: A diagnostic dilemma

We read with great interest the article by Xie et al. [1] entitled “Left ventricular apical aneurysm associated with normal coronary arteries following cardiac surgery: Echocardiographic features and differential diagnosis,” which will be published in the next issue of International Journal of Cardiology.

Prevalence and natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy

Prevalence and natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy

Left ventricular apical aneurysm associated with normal coronary arteries following cardiac surgery: Echocardiographic features and differential diagnosis

Left ventricular aneurysms mainly occur in patients with transmural myocardial infarction caused by left anterior descending coronary artery occlusion. Left ventricular apical aneurysm is rarely found in patients with normal coronary arteriograms, and even rarer in these patients following cardiac operations. We analyzed 37 patients with postoperative left ventricular apical aneurysm, including 1 case from our hospital and 36 cases from the literature; 23 cases (62%) had left ventricular apical true aneurysms and 14 cases (38%) had left ventricular apical pseudoaneurysms, all confirmed at surgery and/or angiography. All cases, with the exception of one, had previously undergone cardiac surgery under cardiopulmonary bypass with apical venting. Although left ventriculography is generally regarded as the gold standard for diagnosis of ventricular aneurysm, echocardiography is an accurate and sensitive method in the evaluation of left ventricular apical aneurysm. Differential diagnosis of left ventricular apical aneurysm includes takotsubo cardiomyopathy, post transapical approach for transcatheter aortic valve implantation, and left ventricular diverticulum.

Left ventricle posterior wall aneurysms with calcified thrombus in the aneurysmal area

Aneurysms can be seen as complications of myocardial infarctions. They are generally located in the apical and anterior segments but left ventricular inferoposterior wall aneurysms are rare. After a myocardial infarction, left ventricular aneurysms can cause symptomatic intractable ventricular arrhythmias. We report a rare case of a left ventricular posterior wall aneurysm containing a calcified thrombus that caused ventricular tachycardia.

Epicardial unipolar radiofrequency ablation for left ventricular aneurysm related ventricular arrhythmia

We report a case of a 62-year-old Chinese man with typical triple-vessel lesions and apical left ventricular aneurysm accompanied with ventricular tachycardia. Off-pump coronary artery bypass (OPCAB) grafting was performed in combination with epicardial unipolar radiofrequency ablation and linear closure of left ventricular aneurysm. The patient recovered well without postoperative complications. Holter monitoring showed no recurrence of the ventricular arrhythmia and the attack frequency of arrhythmia decreased significantly. The patient has been angina-free for 25 months since the operation and shows increasing exercise tolerance. Thus, left ventricular aneurysm plication combined with epicardial unipolar radiofrequency ablation during OPCAB may be beneficial for patients with ventricular aneurysm and preoperative malignant ventricular arrhythmia.

Percutaneous left ventricular partitioning device for chronic heart failure

We report the first implantation of a percutaneous left ventricular partitioning device in the Netherlands. This device is developed for patients with chronic heart failure due to a left ventricular apical aneurysm caused by an anterior myocardial infarction.

Left ventricular apical aneurysm following primary percutaneous coronary intervention

Left ventricular apical aneurysm (LVAA) is a serious complication of acute anterior myocardial infarction (MI). The purpose of our study was to investigate the clinical features of LVAA in the primary PCI era. A total of 161 acute anterior MI patients who had primary PCI and had an echocardiogram on chronic phase were included. The development of LVAA was reviewed on chronic phase. Univariate and multivariate logistic regression analyses were performed to identify the predictors of LVAA. Primary stenting was performed in 160 patients (99.4%). Procedural success was obtained in all patients with a final TIMI flow grade 3 obtained in 142 patients (88.2%). LVAA developed in the chronic phase in 29 patients (18.0%). Multivariate logistic regression analysis revealed that peak CK (500mU/ml increase; OR 1.24, 95% CI 1.09-1.41, p=0.001), heart rate at discharge (5/min increase; OR 1.39, 95% CI 1.03-1.87, p=0.03), final TIMI flow grade ≤2 (vs. TIMI 3; OR 6.95, 95% CI 1.70-28.36, p=0.01) and final myocardial brush grade (MBG) ≤2 (vs. MBG 3; OR 4.33, 95% CI 1.06-17.66, p=0.04) were significantly associated with the development of LVAA. The initial TIMI flow grade or the grade of collateral flow was not associated with LVAA. In conclusion, peak CK, heart rate, and final TIMI flow grade or final MBG ≤2 were significantly associated with the development of LVAA. Achieving a TIMI flow grade 3 by primary PCI may be important for preventing LVAA.

A Primer on Arrhythmias in Patients with Hypertrophic Cardiomyopathy

Patients with hypertrophic cardiomyopathy are at risk of atrial and ventricular arrhythmias, yet treatment options for these patients are made almost solely by extrapolation from patients with other diseases. Heart block may be seen spontaneously but is especially prevalent following septal reduction strategies. Atrial fibrillation is the most common arrhythmia in patients with hypertrophic cardiomyopathy. The onset of atrial fibrillation often represents a turning point clinically for patients, marked by substantial functional deterioration and morbidity. Sudden cardiac death is the most common cause of death in the young patient, but still contributes to mortality in older patients. Major risk factors for sudden cardiac death include resuscitated sudden cardiac death, marked hypertrophy, syncope, and family history of sudden cardiac death due to hypertrophic cardiomyopathy. Minor risk factors for sudden cardiac death include nonsustained ventricular tachycardia, and hypotensive response to exercise. Emerging possible risk factors include atrial fibrillation, myocardial ischemia, left ventricular outflow tract obstruction, genetic mutations, left ventricular apical aneurysms, myocardial fibrosis, and end stage disease.

Epicardial ablation of monomorphic ventricular tachycardia in a case of hypertrophic cardiomyopathy with apical aneurysm

A patient previously diagnosed with hypertrophic cardiomyopathy (HCM) and left ventricular (LV) apical aneurysm on cardiac magnetic resonance imaging ( Figure 1A ), presented with ventricular tachycardia (VT) storm. The 12-lead electrocardiogram of the VT showed negative concordance and northwest axis, suggesting an apical exit site. He had urgent VT ablation guided by three-dimensional mapping system …