International Journal of Clinical Case Reports 2015, Vol.5, No. 46, 1-3
2
tissue removed. Both papillary muscles were exposed
(Figure 2). Aneurysm was repaired with taflon felt and
40 prolene suture. Part of sac was sutured over the felt.
Main concern while repairing the sac was to maintain
mitral valve apparatus in normal situation (Figure 3).
Patient was extubated on 2
nd
post-operative day and
had good hemodynamics on moderate inotropic support
which were tapered off gradually after 24 hours.
Post-operative echo was s/o LVEF: 30%, LAD
territory hypokinesia while post-operative computerised
tomography scan showed good left ventricle morphology
with left ventricle cavity measuring about 53 x 57 x 59
mm
3
(Figure 4) with saphenous graft to left anterior
descending artery patent. Discharged uneventfully on
POD 8
th
in NYHA class I.
Discussion
Johnson and colleagues defined aneurysm as “a large
single area of infarction (scar) that causes the LV ejection
fraction to be profoundly depressed (to approximately
0.35 or lower)”(Johnson and Draggett, 1980)
.
The history of LV aneurysm begun in 1944, when
Beck described fascia lata plication to treat a left
ventricular aneurysm (Beck, 1944). Then, in 1955,
Likoff and Boiley successfully resected an aneurysm
through thoracotomy, using a special clamp, without
cardio-pulmonary by-pass (Likoff and Bailey, 1955).
The modern treatment area begun in 1958 when
Cooley performed a linear repair, using cardio-
pulmonary by-pass (Cooley et al., 1958). Since then,
all the techniques aim to achieve a good left ventricular
anatomy, as close to the normal heart as possible.
In the early stages after the intervention, the mortality
rate is dependent on the surgical technique; the lowest
mortality (3-7%) is associated with patch or linear
closures (Baciewicz et al., 1991; Komeda et al., 1992;
Dor, 1997). Other important early stage mortality risk
factors include age, high class NYHA heart failure,
female gender, EF<30%, pulmonary mean pressure >
33 mmHg, serum creatinine >1.8 mg/dl and failure to
use the internal mammary artery for CABG (Couper
et al., 1990; Baciewicz et al., 1991; Komeda et al.,
1992; Stahle et al., 1994).
Long term prognosis is dependent on the adequacy of
the residual left ventricular function, patients with
severe left ventricular dysfunction having higher
mortality rates (Couper et al., 1990).
Figure 1 Computerised Tomography scan showing lar ge
partially thrombosed LV posterobasal aneurysm approximately
74x72x67 mm
3
Figure 2 Perioperative Photograph showing aneurysm wide
open
Figure 3 Perioperative Photograph showing repaired aneurysm
Figure 4 Post-operative computerised tomography scan
showing repaired aneurysm and its suture line
Posterio basal lv aneurysm is relatively rare and
difficult to repaired because proximity of papillary
muscles and mitral valve apparatus. Another challenge
