International Journal of Clinical Case Reports 2015, Vol.5, No. 46, 1-3
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Case Report Open Access
Left Ventricular Aneurysmorrhaphy
Kothari J. , Baria K., Brahmbhatt B
Department of Cardio Vascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, (Affiliated to B.J.Medical College), New Civil
Hospital Campus, Asarwa, Ahmedabad, India
Corresponding author email
International Journal of Clinical Case Reports, 2015, Vol.5, No.46 doi: 10.5376/ijccr.2015.05.0046
Received: 21 Jul., 2015
Accepted: 22 Aug., 2015
Published: 02 Sep., 2015
Copyright
©
2015 Kothari et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Kothari J.,Baria K.. and Brahmbhatt B., 2015, Left Ventricular Aneurysmorrhaphy, International Journal of Clinical Case Reports, 5(46) 1
-
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Abstract
Left ventricular aneurysm are commonly secondary to coronary artery disease. A postinfarction left ventricular aneurysm
is a well delineated transmural fibrous scar, virtually devoid of muscle, in which the characteristic fine trabecular pattern of the inner
surface of the wall has been replaced by smooth fibrous tissue. In such areas, the wall is usually thin and both inner and outer
surfaces bulge outward. During systole, the involved wall segments are akinetic or dyskinetic.
Patient with history of myocardial infarction with 2 dimensional echocardiography suggestive of left ventricular aneurysm was
evaluated with cardiac computerised tomography scan and underwent surgical correction accordingly. We followed this in
post-operative period in terms of cardiac computerised tomography scan and improvement in NYHA functional class. Pre-operative
cardiac tomography scan proves valuable in planning surgical intervention and surgery done at right time after medical stabilisation
proves to be beneficial for the patient.
Keywords
Left ventricular aneurysm; Aneurysmorrhaphy
Introduction
Left ventricular (LV) aneurysms have long been
described during autopsies. However, it was not until
1881 that they were associated with coronary artery
disease. The first angiographic diagnosis of a LV
aneurysm was made in 1951 (Mills et al., 1993).
The main cause of aneurysm formation, in up to 95%
cases, is coronary artery disease, the rest of the cases being
due to congenital or traumatic causes, Chaga’s disease,
and sarcoidosis, in exceptional cases, due to diverticula of
the left ventricle (Davila et al., 1965; Silverman et al.,
1978; Grieco et al., 1989; De Oliveira, 1998).
We evaluated a patient with history of myocardial
infarction and 2 dimentional echocardiography suggestive
of left ventricular aneurysm. Cardiac computerized
tomography scan suggestive of posterior basal aneurysm
(Figure 1). We followed the patient in post-operative
period in terms of cardiac computerised tomography
scan. Earlier intervention seems beneficial in improving
NYHA functional class.
Case details
45 years old male patient, known case of diabetes
mellitus and hypertension who had complains of
dyspnoea on exertion, NYHA class III for two months
with history of myocardial infarction two months back.
He was admitted for treatment of congestive cardiac
failure. On examination he had bilateral crepitations,
pedal oedema. He was stabilised with medicine and
evaluated with 2 dimensional echocardiography which
was suggestive of left anterior descending and right
coronary artery territory hypokinesia and left ventricular
ejection fraction (LVEF) 20 to 25%, partially
thrombosed left ventricular postero-basal aneurysm
about 65 x 55 mm
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with neck of it around 23 mm;
cardiac computerised tomography scan confirmed the
findings with aneurysm measuring about 74 x 72 x 67
mm
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and neck of it measuring 54 x 38 mm
2
, left
anterior descending and ramus intermedius artery
appeared diffusely narrow in calibre with faint contrast
visualisation (Figure 1).
Surgery performed was left ventricular aneury-
smorrhaphy with coronary artery bypass grafting
anastomosing aorta to saphenous vein to left anterior
descending artery. Aneurysm was arising from
posterior basal part and attached to diaphragmatic
surface. Aneurysm was opened vertically, all scared
