Nelson Dean M, Brennan Anthony P, Raman Jaishankar, Burns Andrew T
Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
Eur Heart J Case Rep. 2024 Mar 20;8(4):ytae143. doi: 10.1093/ehjcr/ytae143. eCollection 2024 Apr.
Left ventricular aneurysms (LVAs) are a well-appreciated complication of acute myocardial infarction. Ventricular aneurysms involving the left ventricle (LV) typically evolve as a result of anterior myocardial infarction and are associated with greater morbidity, complication rates, and hospital resource utilization. Incidence of LVA is decreasing with advent of modern reperfusion therapies; however, in the setting of excess morbidity, clinicians must maintain an appreciation for their appearance to allow timely diagnosis and individualized care.
This case report describes the clinical history, investigation, appearance, and management of a patient with calcified apical LVA with history of previous anterior ST-elevation myocardial infarction. The patient was initially admitted for elective coronary angiography in the setting of worsening exertional dyspnoea and subsequently underwent coronary artery bypass graft, aneurysm resection, and LV reconstruction.
Left ventricular aneurysms are an uncommon complication experienced in the modern era of acute myocardial infarction and current reperfusion therapies, but remain an important cause of excess morbidity and complication. Evidence-based guidelines for the diagnosis, workup, and subsequent management of LVAs are lacking. The imaging findings presented in this case serve as an important reminder of the appearance of LVAs so that timely diagnosis and individualized care considerations can be made.
左心室室壁瘤是急性心肌梗死一种广为人知的并发症。累及左心室（LV）的室壁瘤通常由前壁心肌梗死演变而来，与更高的发病率、并发症发生率以及医院资源利用相关。随着现代再灌注治疗的出现，左心室室壁瘤的发病率正在下降；然而，鉴于其较高的发病率，临床医生必须重视其表现，以便及时诊断和进行个体化治疗。
本病例报告描述了一名患有钙化性心尖部左心室室壁瘤且有既往前壁ST段抬高型心肌梗死病史患者的临床病史、检查、表现及治疗情况。该患者最初因劳力性呼吸困难加重入院接受择期冠状动脉造影，随后接受了冠状动脉搭桥术、室壁瘤切除术及左心室重建术。
左心室室壁瘤是急性心肌梗死现代治疗时代及当前再灌注治疗中一种不常见的并发症，但仍是发病率增加及并发症的重要原因。目前缺乏关于左心室室壁瘤诊断、检查及后续治疗的循证指南。本病例展示的影像学表现可作为左心室室壁瘤表现的重要提示，以便能及时诊断并进行个体化治疗考量。
