IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Left Ventricular Aneurysm
Nasri Alotti, MD, PhD,
Gábor Kecskés, MD
Department of Cardiac Surgery, Zala County Hospital & Pécs University, Zalaegerszeg, Hungary
Nasri Alotti, MD, PhD, Tel: +36 92 500507, Fax: +36 92 500507, Email: nalotti{at}hotmail.com, Department of Cardiac Surgery, Zala County Hospital & Pécs University, 8900 Zalaegerszeg, Zrínyi u. 1, Hungary.
A 62-year-old man presented with chest discomfort and fatigue. He had been diabetic for 22 years and he suffered an acute myocardial infarction 18 years earlier. Chest radiography (Figure 1A
) and computed tomography showed marked calcification on the left ventricular silhouette. The echocardiogram confirmed the diagnosis of left ventricular aneurysm and documented a laminated thrombus and proved a 27% ejection fraction. Coronary angiography demonstrated triple-vessel disease. Under cardiopulmonary bypass and crystalloid cardioplegia, a huge thrombosed and heavily calcified aneurysm was resected (Figures 1B and 1C). Repair was achieved by resection of the extended endocardial calcification, with preservation of the myocardium, and linear approximation with Teflon strips (Figure 1D). The right and circumflex coronary artery were revascularized with saphenous vein grafts. Five years later the patient underwent bilateral amputation of the limbs for a progressive atherosclerosis of the lower extremities, and seven years after the operation the patient is angina free, but has slight limitation of physical activity with prosthetic limbs. His control echocardiogram proved a 33% ejection fraction.
View larger version (124K):
[in this window]
[in a new window]
|
Figure 1. (A) Calcification on the left ventricular silhouette. (B,C) Huge (8 x 10 cm), thrombus consisting, heavily calcified left ventricular aneurysm. Calcification extended to the septum (D) situation after reconstruction.
|
|
Asian Cardiovasc Thorac Ann 2009;
17:334
© 2009 by SAGE Publications
DOI: 10.1177/0218492309339529
