Rupture of true lateral left ventricular aneurysm sparing mitral apparatus; A case report

True postero-lateral ventricular aneurysm occurring in the submitral position is a rare entity and is usually of congenital etiology. Large aneurysms strongly alter cardiac geometry and impair cardiac systolic and diastolic function, resulting in various complications.

We report a case presenting with cardiogenic shock due to the rupture of a large postero-lateral LV aneurysm, successfully managed by emergent surgery and aneurysmectomy. The preoperative trans-thoracic echocardiographic evaluation showed a large size pericardial effusion with large submitral round aneurysm with a thin wall along the postero-lateral border of the LV. The patient was scheduled for emergent operation with high suspicion of post MI lateral free wall rupture and tamponade.

The presented case is very interesting regarding challenge of diagnosis and successful surgical intervention as to date very rare cases of true posterolateral LV aneurysm rupture have been reported in the literature.

Coronary angiography and pathologic examination in this case revealed that the etiology of the patient's posterolateral LV aneurysm might be a silent myocardial infarction in LCX territory, although a less common congenital origin cannot be ruled out completely.