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Improvement of left ventricular aneurysm after myocardial infarction: report of three cases
K Iwasaki1, T Kita, G Taniguchi
1Cardiovascular Center, Sakakibara Hospital, Okayama, Japan.
Insights
Left ventricular aneurysms following myocardial infarction can resolve. Restored coronary blood flow, through recanalization or angioplasty, was linked to aneurysm disappearance in these cases.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Case Studies
Background:
- Left ventricular aneurysms are a recognized complication of myocardial infarction.
- Understanding the factors influencing aneurysm resolution is crucial for patient management.
Observation:
- Three cases of left ventricular aneurysm resolution post-myocardial infarction are presented.
- Coronary blood flow restoration was achieved via spontaneous recanalization (2 cases) or angioplasty (1 case).
Findings:
- Aneurysm resolution correlated with specific diagnostic findings: minimal Q waves on ECG, proximal coronary artery stenosis without collateral filling, no exercise-induced ST changes, and reduced but present thallium-201 uptake.
- Aneurysm disappearance occurred 1 year 8 months to 3 years after myocardial infarction in spontaneous recanalization cases, and after angioplasty in the third case.
Implications:
- These findings suggest that myocardium within a ventricular aneurysm may exhibit hibernating characteristics, even without clear evidence of reversible ischemia or critical stenosis.
- The study highlights the potential for aneurysm regression and informs diagnostic approaches for identifying hibernating myocardium.
Abstract:
We report on the disappearance of a left ventricular aneurysm after myocardial infarction in three cases. Coronary blood flow was restored by spontaneous recanalization in two cases and by angioplasty in one case. When the aneurysm was observed, the findings in these cases were (1) no or limited abnormal Q wave in surface electrocardiography, (2) total or subtotal stenosis of the proximal coronary artery without adequate distal filling through collaterals, (3) no ST shift in exercise electrocardiography, and (4) decreased but not absent thallium-201 uptake in myocardial scintigraphy. In Cases 1 and 2, respectively, 3 years and one year and 8 months after the myocardial infarction, an anginal episode occurred and the ventricular aneurysm disappeared. In Case 3, the aneurysm disappeared after coronary angioplasty. These cases suggest that even without a demonstration of reversible ischemic myocardium and/or severe stenosis without distal filling through collaterals, the myocardium presenting a ventricular aneurysm would be hibernating. These cases were also informative about the detection of hibernating myocardium.