lv aneurysm

7/31/2019 LV Aneurysm

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LV Aneurysm


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Case History

35 yr male

Smoker, Family h/o IHD

July 2005 - Develops fever with sore throat and an episode ofchestpain ; ECG - N

symptoms subside with antibiotics

After 10 days again has fever but now with dyspepsiaTLC raised, CXR N

Treated Antimalarials, antibiotics and for GERD


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After 3 weeks fever again

TLC raised

USG abdomen N

Echo (10/10/05)Dilated LV & LAThinning and hypokinesiaof infero-posterior walls ofthe LV

Mild MRLVEF = 30%


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Coronary Angiography (13/10/05)

Normal LM,LAD & Ramus

Dominant circumflex

with 99% lesion in midsegment

Nondominant normal

RCA


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Left Ventriculogram

Dyskinetic &aneurysmal

postero-basal wall

EF 35%


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Cardiac MRI (18/10/05)

Completely non-viablebasal and mid-inferior

wall.

Large sessile thrombuswithin the aneurysm

EF 30%

Anticoagulation started


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Pt. has NYHA class I symptoms ofbreathlessness

How would you manage this case?

Continue medical therapy

OR

Advice surgical treatment


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Echo (27/3/06)

Dyskinesia ofproximal posteriorwall

Mild MR

EF 25%


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Cardiac MRI (10/4/06)

Aneurysm of basal,mid-inferior and infero-lateral walls

Complete regression ofthrombus

EF 27%


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Aneurysmectomy

done (5/5/06)

Echo (12/6/06)


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NATURAL HISTORY OF LV ANEURYSM

Excellent prognosis of asymptomatic patients series of 40 patients followed for a mean of 5 years and treated medically Of 18 initially asymptomatic patients, 6 developed class II symptoms while 12

remained asymptomatic. Ten-year survival was 90% for these patients but was only 46% at 10 years in

patients who presented with symptoms

Most recent studies report 5-year survival from 47% to 70% in medicallymanaged patients.

Causes of death - arrhythmia in 44%, heart failure in 33%, recurrentmyocardial infarction in 11%, and noncardiac causes in 22%.

Risk of thromboembolism is low for patients with aneurysms (0.35% perpatient-year), and long-term anticoagulation is not usually recommended.However, in the 50% of patients with mural thrombus visible byechocardiography after myocardial infarction, 19% developthromboembolism over a mean follow-up period of 24 months. In thesepatients, anticoagulation and close echocardiographic follow-up may be

indicated.


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INDICATIONS FOR OPERATION

No indications for repairing chronic, asymptomatic aneurysms are

established.

In low-risk patients during operation for associated coronary disease,investigators report repairing large, minimally symptomatic aneurysms.

Operation is indicated for symptoms of angina, congestive heart failure, orselected ventricular arrhythmias. For these symptomatic patients, operationoffers better outcome than medical therapy.

Operation is also indicated in viable patients with contained cardiac rupture,with or without development of a false aneurysm.

Relative contraindications to operation for LV aneurysm include excessiveanesthetic risk, impaired function of residual myocardium outside theaneurysm, resting cardiac index less than 2.0 L/min/m2, significant MR,evidence of hibernating myocardium, and lack of a discrete, thin-walled

aneurysm with distinct margins.

lv aneurysm

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