Surgical treatment of postinfarction thrombosed left ventricle aneurysm formed from coronary artery dissection
Olena K Gogayeva1, Oleksandr O Nudchenko2, Mykola L Rudenko1
1Department of Surgical Treatment of Ischemic Heart Disease, National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.
Insights
Spontaneous coronary artery dissection (SCAD) can cause left ventricle aneurysm (LVA) and thrombus. This case shows successful surgical treatment for a thrombosed LVA after SCAD, despite recurrent thrombosis and embolization.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Spontaneous coronary artery dissection (SCAD) is a cause of acute myocardial infarction (MI).
- Delayed treatment of SCAD can lead to life-threatening complications like left ventricle aneurysm (LVA) with thrombus formation and embolization.
Purpose of the Study:
- To report a case of successful surgical management of a thrombosed LVA secondary to SCAD.
- To highlight the challenges of recurrent thrombosis and embolization in such cases.
Main Methods:
- A 42-year-old male with SCAD developed LVA with thrombus.
- Diagnostic workup included ECG, echocardiography, and coronary angiography.
- Surgical intervention involved coronary artery bypass grafting (CABG), LVA resection, and thrombectomy on-pump.
- Management of recurrent thrombosis and lower extremity artery embolization required reoperation.
Main Results:
- Initial surgery for thrombosed LVA was successful, with patient discharge on postoperative day 8.
- Recurrent thrombosis in the left ventricle apex and lower extremity arteries occurred 15 months post-surgery.
- Redo cardiac surgery was performed successfully, with patient discharge on postoperative day 6.
Conclusions:
- Surgical treatment can be effective for thrombosed LVA resulting from SCAD.
- Uncontrolled anticoagulation therapy may contribute to recurrent thrombosis and systemic embolization.
- Redo cardiac surgery is a viable option for managing recurrent complications.
Background:
Spontaneous coronary artery dissection (SCAD) may lead to acute myocardial infarction (MI), delayed treatment might develop such life-threatening complication as left ventricle aneurysm (LVA) with further embolization due to the presence of a thrombus in the aneurysmal sac.
Material And Methods:
ECG, Echo, coronary angiography and cardiac surgery were performed to a 42-year-old military servant with episodes of dyspnea, dizziness and unconsciousness.
Results:
There were a signs of postinfarction LVA on ECG. Echo study confirmed LVA with moderate decrease of LV ejection fraction (EF) 35 % and floating thrombus. Coronary angio findings were as following: stenosis of LAD up to 50 %, LCX 60 % with spiral dissection of the LAD. We performed CABG, resection of LVA with thrombectomy on-pump. Patient was discharged on 8th postoperative day. In 15 months after surgery ECHO revealed a recurrent thrombosis of LV apex (LV EF 45 %) that is characterized by increased mobility and heterogeneous structure. Ultrasound exam of lower extremities arteries revealed two thrombotic occlusions: one of the right posterior tibial artery in the middle segment, and another of the left anterior tibial artery in the distal segment. Reoperation was performed on-pump (13 min fibrillation and 98 min perfusion time). Patient was discharged on 6th day after surgery.
Conclusion:
Our clinical case demonstrates successful surgical treatment of patient with thrombosed LVA, which appeared after MI due to the coronary artery dissection. Uncontrolled anticoagulation therapy was one of the reasons for recurrent LV thrombosis with low extremities arteries embolization which required on-pump redo cardiac surgery.
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