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(Circulation. 2002;105:1734.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

False Left Ventricular Aneurysm Documented by Magnetic Resonance Imaging

Morten B. Sørensen, MD; Neil E. Moat, MS FRCS; Raad H. Mohiaddin, MRCP FRCR

From the Cardiovascular MR Unit (M.B.S., R.H.M.) and Cardiothoracic Surgery (N.E.M.), Royal Brompton Hospital, London, England, United Kingdom.

Correspondence to Dr Raad Mohiaddin, Cardiovascular MR unit, Royal Brompton Hospital, London SW3 6NP, England, UK. E-mail r.mohiaddin@rbh.thames.nhs.uk

Key Words: AHA Scientific Statements • aging • coronary disease • prevention

A 57-year-old man presented with shortness of breath on exertion following an inferior myocardial infarction 5 months previously. Echocardiogram at the local hospital showed a grossly dilated left ventricle (diameter 9.4 cm) with an ejection fraction of 29%. A ventriculogram confirmed the diagnosis of a large left ventricular (LV) aneurysm, and the patient was referred for surgical assessment and possible intervention. Presurgical cardiovascular magnetic resonance (CMR) for detailed delineation of the anatomy showed a large false aneurysm (Figures 1 and 2) of the posterior LV free wall, measuring a maximum of 102 mm (LR) by 61 mm (anteroposterior) in the transaxial plane. The aneurysm com- municated freely with the LV through a 3-cm lumen. A mural thrombus was seen in the posterior part of the aneurysm. The LV was dilated (LV end-diastolic volume 219 mL) and hypokinetic (LV ejection fraction 24%). The inferior myocardial wall in close proximity to the aneurysm enhanced significantly after gadolinium, which was consistent with scaring after a previous transmural myocardial infarction in this area (Figure 2). Subsequently, the aneurysmal sac was excised with a patch closure of the LV defect. The postsurgical period was uneventful. In this patient, CMR helped surgical planning by defining the relation between papillary muscles and the aneurysm and by delineating viable and nonviable myocardial territories.

View larger version (133K): [in this window] [in a new window]   Figure 1. TrueFISP image in the horizontal long-axis plane showing the left ventricle (LV) with a large false aneurysm (A). A mural thrombus (T) is seen in the posterior part of . . . [Full Text of this Article]

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