An Unusual Suspect in a Case of Left Ventricular Aneurysm

Abstract

True left ventricular aneurysms are most frequently seen after acute transmural myocardial infarction. These aneurysms are distinct from apical left ventricular pseudoaneurysms, which can also be seen in ischemia, and have a different treatment course. A major dilemma for clinicians is using echocardiographic information to make this distinction. Coronary angiography aids in this distinction; however, in the case of normal coronaries alternate etiologies must be considered. The differential for a patient with a left ventricular aneurysm and normal coronaries or no prior cardiac surgery is broad and includes traumatic, infectious and infiltrative causes. In this e-challenge, we present an unusual cause of a left ventricular apical aneurysm in a patient with normal coronary arteries residing in the United States.

Chagas Disease and the Kissing Bug: An Invisible Giant

“…Babb et al report a case of Chagas in a patient who had previously immigrated to the United States and presented with chest pain and symptoms of heart failure. 9 The patient was found to have a large left apical aneurysm, which was surgically managed. Left ventricular apical aneurysms represent the most common echocardiographic abnormality and are seen in over 50% of Chagas patients with cardiac involvement.…”

“…Aneurysm size is variable, ranging from small "hollow punch" lesions to large aneurysms (as seen in the case reported by Babb et al), hardly distinguishable from those seen with myocardial infarction. 9,25,26 In some circumstances (refractory arrhythmias, systolic dysfunction with ventricular dyskinesia, intra-ventricular thrombus formation), it is possible that patients with large aneurysms could benefit from surgical resection. There is a need for evidence.…”