Abstract 3079: Giant Left Ventricular Aneurysm as a Late Complication of Inferior Myocardial Infarction
A 62 year-old man presented three days after experiencing an inferior myocardial infarction. Angiography demonstrated an occluded distal right coronary artery, and no intervention was attempted due to a completed infarct. Thereafter, he experienced weeks of heart failure symptoms, which culminated in syncope. Echocardiography showed organized inferior pericardial hematoma and tamponade, and he underwent emergent surgical evacuation of the hematoma and patch repair of a ruptured inferior wall. He recovered, but continued to have fatigue two months later despite appropriate medical therapy. His physical exam revealed a holosystolic murmur near the apex and a pulsatile abdomen on inspection. Repeat echocardiography showed a left ventricular ejection fraction of 25%, evidence of an inferior aneurysm and severe mitral regurgitation. Cardiac MRI demonstrated a giant inferior left ventricular aneurysm, measuring 9 centimeters in diameter, extending from the mitral annulus to near the apex. The aneurysm dwarfed the functional portion of the ventricle, and the left ventricular end-systolic volume was 740 cc. After preparing for the possibility of requiring mechanical circulatory support, he underwent ventricular reconstruction with a triangular Dacron patch, fitted from inferior base to apex, with oversewing of the excluded aneurysm. He also underwent mechanical mitral valve replacement and left anterior descending coronary artery bypass. He required no post-operative mechanical support and was discharged home 13 days later on standard heart failure medications and anticoagulation. His presentation highlights multiple complications after a late-presenting myocardial infarction, the controversy over indications for ventricular reconstruction, and the importance of recognizing individual cases both in the context of clinical trials and for the characteristics that make them unique.