Giant left ventricular aneurysm complicating silent inferoposterior myocardial infarction

A Case Report of a Double Catastrophe: True Left Ventricular Aneurysm and Ventricular Septal Rupture Complicating Acute Myocardial Infarction and Presenting as Chronic Heart Failure

A combination of left ventricular aneurysm (LVA) and ventricular septal rupture (VSR) in an acute myocardial infarction (AMI) patient presenting as heart failure is extremely rare. Here, we report a rare case of concurrent true inferoposterior LVA and VSR secondary to inferior wall myocardial infarction (IWMI) presenting as chronic heart failure (CHF). To the best of our knowledge, this is the third reported case in the literature. A 61-year-old man, who had an IWMI about one month prior, presented with CHF. Echocardiography revealed true inferoposterior LVA and VSR. Coronary angiography revealed double vessel disease involving the right coronary artery (RCA) and left circumflex artery (LCX). Left ventricular angiography confirmed a large posterobasal aneurysm and VSR. The patient underwent successful coronary artery bypass grafting (CABG) and ventriculoplasty along with VSR patch repair.

Concurrent true inferoposterior left ventricular aneurysm and ventricular septal rupture secondary to inferior myocardial infarction: a case report

Background

Although left ventricular aneurysm (LVA) is the most common mechanical complication of myocardial infarction (MI), it rarely involves the inferior or posterior left ventricular wall. Ventricular septal rupture (VSR) may be a fatal mechanical complication of MI but rarely occurs in the posterior or inferior portion of the interventricular septum. Thus, LVA and VSR as two mechanical complications of MI in the same patient are extremely rare.

Case summary

A 65-year-old woman, who had inferior ST-segment elevation myocardial infarction 2 months before without reperfusion therapy, was admitted with exertional dyspnoea for 1 month. Echocardiography and computed tomography revealed true inferoposterior LVA and VSR as concurrent complications of MI. These imaging findings were confirmed during cardiac surgery. After successful coronary bypass grafting and ventriculoplasty, the patient recovered quickly and was discharged from the hospital.

Discussion

A rare case of post-infarction inferoposterior LVA with concurrent interventricular septal rupture was reported. Transthoracic and transoesophageal echocardiography and cardiac computed tomography were valuable tools for the diagnosis of this rare condition. Combined coronary bypass grafting and ventriculoplasty were effective in treating this often fatal complication of inferior MI.

Hybrid trans-apical device closure of left ventricular pseudoaneurysm under trans-oesophageal echocardiographic guidance

Left ventricular pseudo aneurysm (LVPA) results from contained left ventricular free wall rupture following either myocardial infarction or cardiac surgery. Untreated LVPA carries approximately 30-45% risk of rupture in the first year. Conventional treatment for LVPA is surgery which carries a mortality of about 20%. Interventional closure of LVPA has been reported from trans-arterial and trans-apical routes. Here we report successful hybrid closure of a LVPA under trans-oesophageal echocardiogram (TEE) guidance.