Direct ablation and excision of myocardial scar in post-myocarditis ventricular aneurysm

The patient was a 34-year-old woman who developed multiple post-myocarditis ventricular aneurysms with ventricular tachyarrhythmia. After implantation of an intracardiac defibrillator, she experienced multiple episodes of counter-shock. An electrophysiological study demonstrated an early excitation circuit entering the septal aneurysm with the right ventricular aneurysm as an exit. A surgical ablation of the re-entry and left ventricular plasty with scar resection was performed. The operation was performed under direct, epicardial electrophysiological guidance. A cryoablation was performed along the right ventriculotomy and the margin of the left ventricular aneurysm. The left ventricle was closed using endoventricular aneurysmorrhaphy and the right ventriculotomy was closed directly. No recurrence of ventricular tachyarrhythmia has been encountered.