[Giant Left Ventricular Aneurysm After Double Patch Closure of Ventricular Septal Perforation Through Right
Kuntae Ahn1, Hiroyuki Hayashi, Nobuyuki Yoshitani
1Department of Cardiovascular Surgery, Akashi Medical Center, Akashi, Japan.
Insights
A patient developed a giant left ventricular aneurysm after surgery for ventricular septal perforation. This highlights the risk of aneurysm formation following right ventriculotomy for myocardial infarction complications.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Imaging
Background:
- A 66-year-old male experienced myocardial infarction (MI) due to left anterior descending (LAD) artery occlusion.
- The MI complicated with ventricular septal perforation (VSP), a rare but serious event.
Observation:
- VSP was surgically repaired using a right ventricle incision with double patches and glue.
- Postoperative echocardiography revealed a persistent infarcted left ventricular anterior wall, a consequence of the right ventriculotomy approach.
- This led to the development and gradual enlargement of a giant left ventricular aneurysm (LVA).
Findings:
- Left ventriculoplasty was performed 29 months post-VSP repair due to heart failure symptoms (respiratory distress).
- The case underscores the long-term risk of LVA formation after right ventriculotomy for VSP in MI patients.
Implications:
- Right ventriculotomy for VSP repair in MI patients carries a risk of delayed left ventricular aneurysm formation.
- Careful long-term cardiovascular imaging follow-up is crucial for detecting and managing LVAs.
- Alternative surgical approaches may be considered to mitigate the risk of LV wall thinning and subsequent aneurysm development.
Abstract:
A 66-year-old man. He had myocardial infarction due to occlusion of the left anterior descending branch, which was subsequently complicated by ventricular septal perforation. Ventricular septal perforation was repaired through right ventricle incision, applying double patches for closure, and injecting glue between the patches. The early postoperative course was good, but the infarcted left ventricular anterior wall remained because of the right ventriculotomy approach. A left ventricular aneurysm was demonstrated on postoperative follow-up echocardiography, which gradually enlarged to become giant. Since symptoms of heart failure such as respiratory distress appeared, left ventriculoplasty was performed 29 months after the perforation of the initial surgery. Since thinned left ventricular wall remains following right ventriculotomy approach, risk of postoperative left ventricular aneurysm should be taken into account.
