The Successful Surgical Treatment of a Giant True Left Ventricular Aneurysm: a Case Report
Y. B. Brand,
M. K. Mazanov,
E. N. Ostroumov,
M. A. Sagirov,
N. I. Kharitonova,
M. V. Chumakov,
D. V. Chernyshev https://doi.org/10.23934/2223-9022-2018-7-4-372-377
Abstract
We report the successful surgical treatment of a giant true thrombosed aneurysm of the left ventricle.
A 59-year-old male patient Z. was admitted with severe heart failure and chronic thrombosed aneurysm of the left ventricle, formed after acute extensive myocardial infarction, despite successful installation of a stent into the anterior descending artery in the acute period. Echocardiography revealed a significant increase in the volume of the left ventricular cavity, a significant decrease in the contractile function of the left ventricular myocardium (ejection fraction 32-36%), a giant left ventricular aneurysm (9x6 cm) with a parietal lining thrombus in the aneurysm cavity. Coronary angiography showed an aneurysmal dilatation of the circumflex branch of more than 6 mm, hemodynamically significant stenosis of two coronary arteries. According to the scintigraphy, the myocardium beyond the scar tissue was viable. The patient underwent resection of a left ventricular aneurysm, endoventricular plasty (Dor procedure), coronary artery bypass surgery of the circumflex artery and obtuse marginal branch of the left coronary artery.
The patient was discharged in satisfactory condition on day 14 after surgery. At follow-up 6 months after surgery, an increase in the ejection fraction to 3941% was noted.
About the Authors
Y. B. Brand
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department
Russian Federation
Russian Federation
Brand Yakov Beniaminovich - Dr. Med. Sci., professor, Head of the Emergency Coronary Surgery Department.
3 Bolshaya Sukharevskaya Square, Moscow 129090
M. K. Mazanov
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department
Russian Federation
Russian Federation
Mazanov Murat Khamidbiyevich - Cand. Med. Sci., Senior Researcher of the Emergency Coronary Surgery Department.
3 Bolshaya Sukharevskaya Square, Moscow 129090
E. N. Ostroumov
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department
Russian Federation
Russian Federation
Ostroumov Evgenij Nikolaevich - Dr. Med. Sci., professor, Senior lecturer, Emergency Coronary Surgery Department.
3 Bolshaya Sukharevskaya Square, Moscow 129090
M. A. Sagirov
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department
Russian Federation
Russian Federation
Sagirov Marat Anvarovich - Cand. Med. Sci., Head of the Emergency Coronary Surgery Department.
3 Bolshaya Sukharevskaya Square, Moscow 129090
N. I. Kharitonova
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department
Russian Federation
Russian Federation
Kharitonova Nadezda Ivanovna - Senior Researcher of the Emergency Coronary Surgery Department.
3 Bolshaya Sukharevskaya Square, Moscow 129090
M. V. Chumakov
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department
Russian Federation
Russian Federation
Chumakov Mikhail Viktorovich - Cand. Med. Sci., Head of the Department of Anesthesiology no 2.
3 Bolshaya Sukharevskaya Square, Moscow 129090
D. V. Chernyshev
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department
Russian Federation
Russian Federation
Chernyshev Dmitry Vladimirovich - Cardiovascular surgeon, Emergency Coronary Surgery Department.
3 Bolshaya Sukharevskaya Square, Moscow 129090
References
1. Бураковский В.И., Бокерия Л.А. Сердечно-сосудистая хирургия: рук-во. 2-е изд., доп. М.: Медицина, 1996. 768с. [Burakovskij V.I., Bokeriya L.A. // Serdechno - sosudistaya hirurgiya: ruk-vo. 2-e izd., dop. M.: Medicina, 1996. 768s. (In Russian)].
2. Tikiz H., Atak R., Balbay Y., et al. Left ventricular aneurysm formation after anterior myocardial infarction: clinical and angiographic determinants in 809 patients. // Int. J. Cardiol. 2002; 82(1): 7-14; discussion 14-16.PMID: 11786151 doi: 10.1016/S0167-5273(01)00598-8
3. Abrams D.L., Edelist A., Luria M.H., Miller A.J. Ventricular aneurysm. a reappraisal based on a study of sixty-five consecutive autopsied cases. // Circulation. 1963; 27: 164-169. PMID: 14173484 doi: 10.1161/01.CIR.27.2.164
4. Jones R.H., Velazquez E.J., Michler R.E., et al. Coronary bypass surgery with or without surgical ventricular reconstruction. // N. Engl. J. Med. 2009; 360(17): 1705-1717. PMID: 19329820 doi: 10.1056/NEJMoa0900559
5. Mills N.L., Everson C.T., Hockmuth D.R. Technical advances in the treatment of left ventricular aneurysm. // Ann. Thorac. Surg. 1993; 55(3): 792-800. PMID:8452458
6. Cohn L.H. Cardiac surgery in the adult. 3rd ed. New York: McGraw Hill, 2008: 803, 815.
7. Бранд. Я.Б., Долгов И.М., Мазанов М.Х., и др. Успешное хирургическое лечение гигантской ложной аневризмы левого желудочка. // Визуализация в клинике. 2004; (24-25): 55-60.
8. Бранд. Я.Б., Долгов И.М., Мазанов М.Х., и др. Случай успешного хирургического лечения наружных разрывов миокарда левого желудочка. // Грудная и сердечно-сосудистая хирургия. 2005; (1): 63-67.
9. Kirklin J.W., Barratt-Boyes B. Cardiac surgery. New York: Churchill Livingstone, 1993.
10. Glower D.G., Lowe E.L. Left ventricular aneurysm. In: Edmunds LH. (ed.) Cardiac surgery in the adult. New York: McGraw-Hill, 1997.
11. Dor V. Left ventricular reconstruction: the aim and the reality after twenty years. // J. Thorac. Cardiovasc. Surg. 2004; 128(1): 17-20. PMID:15224016 doi:10.1016/j.jtcvs.2004.02.026
12. Чернявский А.М., Марченко А.В., Хапаев С.А., и др. Реконструктивная хирургия постинфарктных аневризм левого желудочка сердца. // Патология кровообращения и кардиохирургия. 2000; (1-2): 30-35. [Chernyavskij A.M., Marchenko A.V., Hapaev S.A., i dr. Rekonstruktivnaya hirurgiya postinfarktnyh anevrizm levogo zheludochka serdca. // Patologiya krovoobrashcheniya i kardiohirurgiya. 2000; (1-2): 30-35. (In Russian)].
13. Cooley D.A. Ventricular endoaneurysmorrhaphy: a simplified repair for extensive postinfarction aneurysm. // J. Card. Surg. 1989; 4(3): 200-205. PMID:2535278
14. Menicanti L., Di Donato M. The Dor procedure: what has changed after fifteen years of clinical practice? // J. Thorac. Cardiovasc. Surg. 2002; 124(5): 886-890. PMID:12407369
15. Michler R., Rouleau J., Al-Khalidi H., et al. Insights from the STICH trial: Change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction. // J. Thorac. Cardiovasc. Surg. 2012; 146(5): 1139-1145. e6. PMID:23111018 doi: 10.1016/j.jtcvs.2012.09.007.
Review
For citations:
Brand Y.B., Mazanov M.K., Ostroumov E.N., Sagirov M.A., Kharitonova N.I., Chumakov M.V., Chernyshev D.V. The Successful Surgical Treatment of a Giant True Left Ventricular Aneurysm: a Case Report. Russian Sklifosovsky Journal "Emergency Medical Care". 2018;7(4):372-377. https://doi.org/10.23934/2223-9022-2018-7-4-372-377
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