Massive Left Ventricular Aneurysm
A 67-year-old woman with a history of hypertension, diabetes mellitus, and hyperlipidemia presented with mild exertional dyspnea of several-month’s duration. An ECG (Figure 1) done 1 month earlier had shown Q-waves and 1-mm ST-elevation in leads II, III, and aVF, a new finding compared with an ECG done 2 years earlier. A pharmacological stress test showed inferior infarct and apical ischemia, which prompted a left heart catheterization. The coronary angiogram revealed an occluded right coronary artery and the left ventriculogram demonstrated a massive basal inferior aneurysm with possible thrombus (Figure 2; Movie I and Movie II). A transesophageal echocardiogram confirmed the diagnosis of left ventricular aneurysm and documented a laminated thrombus within the aneurysm (Figure 3; Movie III). Resection of the aneurysm was recommended, but the patient declined. At a follow up visit 2 months later, she had New York Heart Association functional class II symptoms and was being treated with an angiotensin-converting enzyme inhibitor, a β-blocker, and systemic anticoagulation.
Movies I through III are available in the online-only Data Supplement at http://www.circulationjournal.org.
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.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.