Giant inferolateral left ventricular aneurysm post inferior myocardial infarction

Abstract

A 64‐year‐old male presented with dyspnea New York Heart Association class IV 6 months post‐ST elevation myocardial infarction. Echocardiography showed a giant left ventricular aneurysm (LVA) with overlaying thrombus, and ejection fraction 25% (Figure 1A), ischemic severe mitral regurgitation, functional severe tricuspid regurgitation, and pulmonary hypertension 60mmHg. Computed tomography CT scan revealed LVA measuring 6 × 8 cm (Figure 1B,C). Nuclear scanning showed nonviable scar tissue at the inferior surface of the left ventricle. The patient underwent surgical repair through a median sternotomy with central aortic and bicaval cannulation and antegrade Del Nido cardioplegia. The inferior LVA was freed from the adhesions to the pericardium and excised. The entire scar tissue was resected leaving a 1‐cm rim to secure the sutures, which were linear from the base to the apex (Figure 1D). Mitral valve replacement was performed with Mosaic tissue valve 27mm (Medtronic Inc, Minneapolis, MN) via a transseptal approach. The tricuspid valve was repaired using a 26mm Medtronic 3D contour ring (Medtronic Inc). The heart restored the rhythm spontaneously; however, attempts to come off the pump were unsuccessful. An intra‐aortic balloon pump was inserted through the right femoral artery, and central extracorporeal membrane oxygenation support was connected. The ventricular function recovered gradually, and the patient was weaned from mechanical support and discharged home after 16 days.