Calcified left ventricular apical aneurysm with intramural thrombus: a case report
Dean M Nelson1, Anthony P Brennan1, Jaishankar Raman2
1Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
Insights
Left ventricular aneurysms (LVAs) are a rare complication of heart attacks. This case highlights the importance of recognizing LVA appearance for timely diagnosis and personalized treatment, despite declining incidence.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Left ventricular aneurysms (LVAs) are a recognized complication of acute myocardial infarction, particularly anterior MIs.
- While decreasing due to reperfusion therapies, LVAs are associated with significant morbidity and resource utilization.
- Clinicians need to maintain awareness of LVA presentation for prompt diagnosis and tailored patient care.
Background:
Left ventricular aneurysms (LVAs) are a well-appreciated complication of acute myocardial infarction. Ventricular aneurysms involving the left ventricle (LV) typically evolve as a result of anterior myocardial infarction and are associated with greater morbidity, complication rates, and hospital resource utilization. Incidence of LVA is decreasing with advent of modern reperfusion therapies; however, in the setting of excess morbidity, clinicians must maintain an appreciation for their appearance to allow timely diagnosis and individualized care.
Case Summary:
This case report describes the clinical history, investigation, appearance, and management of a patient with calcified apical LVA with history of previous anterior ST-elevation myocardial infarction. The patient was initially admitted for elective coronary angiography in the setting of worsening exertional dyspnoea and subsequently underwent coronary artery bypass graft, aneurysm resection, and LV reconstruction.
Discussion:
Left ventricular aneurysms are an uncommon complication experienced in the modern era of acute myocardial infarction and current reperfusion therapies, but remain an important cause of excess morbidity and complication. Evidence-based guidelines for the diagnosis, workup, and subsequent management of LVAs are lacking. The imaging findings presented in this case serve as an important reminder of the appearance of LVAs so that timely diagnosis and individualized care considerations can be made.
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