False Left Ventricular Aneurysm Documented by Magnetic Resonance Imaging
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.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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