Thorac Cardiovasc Surg 2012; 60 - P86
DOI: 10.1055/s-0031-1297877

Repair of a giant true posteroinferior left ventricular aneurysm

AJ Penkalla 1, YG Weng 1, N Solowjowa 1, M Dandel 1, R Hetzer 1, C Knosalla 1
  • 1Deutsches Herzzentrum Berlin, Herz-, Thorax- und Gefäßchirurgie, Berlin, Germany

Introduction: Posterior left ventricular (LV) aneurysm is an uncommon complication of acute myocardial infarction or surgery. The incidence of post-infarct LV aneurysms is reported to be 10–30%. Inferoposterior LV aneurysms account for only 3% of all true LV aneurysms. We present a rare case of post-infarction giant true posteroinferior aneurysm.

Aims: A 58-year-old male patient had undergone cardiac surgery for patch VSD closure, reconstruction of the posterior LV wall and single-vessel coronary bypass grafting following posterolateral myocardial infarction, complicated by ventricular septal defect and cardiogenic shock 2 years previously. While he had recovered well from surgery he suffered from progressive congestive heart failure (NYHA III) during the past year. He was admitted to our institution for evaluation for heart transplantation. Echocardiography revealed a giant aneurysm of the posterior wall with a maximal diameter of 8cm, and mild mitral regurgitation. LV ejection fraction was 15%. Subsequent dual-source computed tomography (CT) confirmed a giant true aneurysm of the LV posterior wall measuring 70×75×82mm with epicardial continuity (Figure).

The aneurysm was completely excised and the LV was closed by direct suture using two Teflon strips to reinforce the ventricular suture on the outside. LV end diastolic volume was reduced from 787ml to 247ml as measured on CT. LV ejection fraction increased to 50% without any signs of mitral regurgitation. LV systolic peak global strain improved from 2% shortening to 6.8% shortening. Our patient was discharged 14 days after operation in good condition.

Fig.1: CT scan

Discussion: Extensive posterior left ventricular aneurysm presents a surgical challenge. This case illustrates how surgical reconstruction is able to restore left ventricular geometry and function. 2-D strain echocardiography in combination with dual source cardiac CT facilitates preoperative planning in order to achieve optimal surgical results.