Posterobasal left ventricular aneurysm after myocardial infarction with normal coronary arteries: Case-report

Abstract

We present a case of a 64-year-old woman with signs of debilitating condition including anginal chest pain, exertional dyspnea, and depression. The patient had previously suffered from a myocardial infarction after a loss of a close family member. Workup showed a posterobasal left ventricular aneurysm and moderate to severe mitral regurgitation in the absence of coronary atherosclerosis. Routine ultrasonography revealed abdominal aortic aneurysm and intraabdominal aortic deviation. The patient was immediately started on optimal medical treatment. On repeat assessment general condition was satisfactory, vital signs were normal, and investigations showed no signs of progressive heart failure or other significant clinical changes. Although prognosis in patients with myocardial infarction with normal coronary arteries is generally considered favorable, mechanical complications such as posterobasal left ventricular aneurysm with moderate to severe mitral regurgitation are possible.

Left Ventricular Apical Aneurysm in a Patient with Hypertrophic Cardiomyopathy Diagnostic and Management Dilemmas

“…The proposed mechanisms for MINOCA include coronary vasospasm, coronary thrombosis in situ or embolization from distal source with spontaneous lysis, cocaine abuse, viral myocarditis, aortic dissection, hypercoagulable states, autoimmune vasculitis and carbon monoxide poisoning [6]. MINOCA has been rarely associated with the development of an LV aneurysm [7]. In the case we are presenting the careful reading of the ECGs and the negative coronary angiography was the clue for the final diagnosis.…”

Surgical treatment of left ventricular aneurysm in patients with prior myocardial infarction in the absence of obstructive coronary artery disease (MINOCA): a cohort study

“…Only case reports exist to address this conundrum. The therapeutic strategies vary from optimal medical treatment [ 9 ] to left ventricular reconstruction [ 7 , 8 ] to epicardial ablation [ 6 ]. The indication for surgery in our patient series was consistent with Li B’s [ 7 ] and Takaseya’s reports [ 8 ].…”

“…Most studies have shown better outcomes than their acute myocardial infarction-obstructive coronary artery disease counterparts [ 13 , 35 , 36 ]. However, there were only case reports reporting the prognosis of patients with MINOCA and left ventricular aneurysm, with different management strategies implemented [ 6 – 9 ]. In our series, surgical indications for patients without obstructive coronary arteries were accordant with those with obstructive coronary arteries.…”

“…However, there is a small proportion of patients in whom left ventricular aneurysm occurs, refractory to medical treatment and even implantable cardioverter defibrillator. And only small sample size cohort literature and case report exist to address this conundrum [ 6 – 9 ].…”