Successful repair of a rare submitral aneurysm with basal septal defect: a technique combining edge-to-edge repair and patch exclusion

Submitral left ventricular aneurysm (SLVA) is an exceedingly rare clinical entity associated with high mortality due to potential rupture, systemic embolism, and severe mitral regurgitation (MR). Surgical management is complex, necessitating strategies that address both the aneurysm and the valvular pathology while preserving ventricular geometry. We present the case of a 44-year-old male presenting with syncope and acute heart failure. Multi-modality imaging, including cardiac magnetic resonance imaging (MRI), revealed a large (7.4 × 6.9 cm) basal septal left ventricle (LV) aneurysm with a thick mural thrombus and severe MR secondary to anterior leaflet tethering. Coronary angiography ruled out ischemic etiology. Under cardiopulmonary bypass, the mitral valve was accessed via a paraseptal left atrial approach. An Alfieri stitch (edge-to-edge repair) was utilized to correct the leaflet prolapse, achieving competent coaptation. The aneurysm was approached externally; the cavity was incised, and the thrombus evacuated. The 2.5-cm aneurysmal neck was excluded using an autologous pericardial patch, followed by a double-layer linear aneurysmorrhaphy to obliterate the cavity. The patient had an uneventful postoperative course and was discharged on day 9. This case demonstrates that a combined approach-aneurysm exclusion via pericardial patch and concomitant edge-to-edge mitral valve repair-provides a durable, safe solution for SLVA. This strategy effectively eliminates the embolic source and restores valvular competence without compromising left ventricular function.

The online version contains supplementary material available at 10.1007/s12055-026-02212-w.