Unrecognized concomitant ventricular septal rupture and left ventricular aneurysm 10 months after myocardial infarction in a patient presenting with chronic heart failure

Background We report a rare case of concomitant inferior left ventricular aneurysm and ventricular septal rupture in a patient presenting with chronic heart failure. Case presentation An 81-year-old man suffered from congestive heart failure. His symptoms were alleviated by medical management; however, heart failure symptoms continued according to the New York Heart Association Functional Classification III. Ten months after presentation, ventricular septal rupture was diagnosed using echocardiography. The left ventricular aneurysm was also complicated. Surgical repair of the ventricular septal rupture and left ventricular aneurysm was successfully performed. The ventricular septal rupture consisted of multiple holes, and the infarcted myocardium had already progressed to firm, fibrotic scar tissue. We closed the ventricular septal rupture with a small bovine pericardial patch and performed an aneurysmectomy with a liner technique. Conclusions Cases of ventricular septal rupture can have various clinical scenarios, and treatment should be optimized for each patient, especially with respect to the timing of surgery.

Case Report: A Case of Unusual Combination of Hypothyroidism, Myocardial Bridging, and Myocardial Infarction-Induced Left Ventricular Aneurysm

Background: Myocardial bridging (MB) of the coronary artery is a congenital anatomical variation, which has traditionally been considered a benign condition that does not cause cardiovascular events. However, recent studies have shown that MB is associated with major adverse cardiac events, including angina, myocardial infarction, arrhythmia, syncope, and even sudden death.Case: We report a case of a 41-year-old man who had hypothyroidism and MB associated with ventricular aneurysm following myocardial infarction. This patient was admitted to our hospital because of 11 days of sudden discomfort and pain in the chest. An electrocardiogram on admission showed an old myocardial infarction. Coronary angiography showed MB in the distal segment of the left anterior descending artery. Left ventricular angiography, which was performed using a pigtail catheter, showed ventricular aneurysm formation. Thyroid ultrasound demonstrated hypothyroidism and Hashimoto's thyroiditis. Patients with hypothyroidism and MB have a high risk of acute myocardial infarction or even sudden death.Conclusion: Observations in our case suggest that early recognition of hypothyroidism and MB is important for risk stratification and prognosis in patients with myocardial necrosis and acute coronary syndrome. Additionally, this early recognition may have positive effects on cardiovascular outcomes in patients with hypothyroidism.

Major Complication Following Kawasaki Disease in an Infant—The Development of Apical Infarction and Aneurysm Formation

Considerable advances have occurred in the understanding of Kawasaki disease, with a substantial drop in morbidity and mortality following the infusion of gamma globulin during the acute phase. Nevertheless, major complications may still occur. A 27-year-old male presented as an infant of 11 weeks when he was diagnosed as having Kawasaki disease. He was appropriately treated with aspirin and a gamma globulin infusion following his diagnosis 5 days after the onset of his illness. Despite that, he went on to develop coronary aneurysms. He represented a few weeks later with a history of inconsolable crying associated with pallor, suggestive of ischaemic chest pain. A repeat echocardiogram revealed infarction of the apex of the left ventricle with localised thrombus formation. There were persistent aneurysms within both coronary artery systems. A further infusion of gamma globulin was given. In view of the thrombus formation, he was started on warfarin. The thrombus gradually resolved with the development of a clearly defined left ventricular apical aneurysm. He has remained on warfarin, aiming for an international normalised ratio (INR) level of 2 to 2.5. He developed mild left ventricular dysfunction during late childhood, which improved following the commencement of an angiotensin-converting enzyme (ACE) inhibitor. Despite his ventricular aneurysm, there has been no documented evidence of ventricular tachycardia over the years. Repeated testing initially by nuclear perfusion scans and then by stress echocardiograms failed to show any inducible ischaemia apart from the apical ventricular aneurysm. A recent computed tomography (CT) coronary angiogram revealed an ectatic origin of the left main and the right coronary arteries with mild calcification involving the mid-portion of the latter and slight calcification of the former. His raised cholesterol level has responded well to a statin. Despite the persistence of the ventricular aneurysm, he continues to be managed conservatively, as he has remained well. The question arises as to what the long-term implications are of his left ventricle apical aneurysm. Should it be excised? Is he at risk for ventricular tachycardia and sudden death? In addition, although the coronary aneurysms have resolved, the CT coronary angiogram shows calcium plaques in both coronary arteries at the site of the earlier aneurysms. This finding raises the question as to whether all children who develop coronary artery aneurysms following Kawasaki disease should have a CT coronary angiogram performed in adulthood.

Strain Analysis Using Feature Tracking Cardiac Magnetic Resonance Predict Prognosis of Patients With Ventricular Aneurysm After Myocardial Infarction

Objective We aim to assess the left ventricular strain in patients with ventricular aneurysm(VA) after myocardial infarction(MI) using cardiac magnetic resonance-feature tracking (CMR-FT) and to evaluate its value for long term prognosis of patients.Methods Sixty-five patients who underwent CMR with VA after MI from January 2018 to December 2019 in Drum Tower Hospital Affiliated Hospital of Nanjing University School of Medicine were selected for the study. They were divided into two groups based on New York Heart Association (NYHA): 25 cases of NYHA I as group A and 40 cases of NYHA II-IV as group B. CMR was performed in both groups to quantify the parameters of overall and segmental left ventricular myocardial strain in patients with aneurysm. 37 of whom underwent a second CMR 3-12 months after cardiac infarction to investigate the effects of aneurysm on patients' left ventricular strain and left ventricular cardiac function.Results Patients from group B have larger VA basilar transverse diameter and significant more impaired LV Global longitudinal strain(GLS)、Global circumferential strain(GCS)、Global radial strain(GRS) (-12.34±7.31 vs. -7.68±6.11;p=0.0072, -21.31±13.49 vs. -14.93±10.44;p=0.0361, 37.13±27.87 vs. 22.00±20.05;p=0.0135) without change in infarct size. GLS, GCS, GRS were significant indicators of NYHA classification after AMI by multivariate regression analysis.Conclusions Myocardial strain assessed by CMR-FT may be an independent predictor of NYHA of patients with aneurysm after MI and could be used for identifying high-risk patients with VA.