Post infarction left ventricular aneurysm and ventricular septal defect-a clinical experience at SSKM Hospital Kolkata

Patients with apical transmural myocardial infarctions are at higher risk of aneurysmal formation, followed by those with posterior-basal infarcts. Ventricular septal defect formerly occurred in 1% to 2% of patients after acute myocardial infarction in the prethrombolytic era. The incidence has dramatically decreased with reperfusion therapy. Fourty five years old housewife was admitted with an acute anterior infarction who had developed Ventricular septal defect and left ventricular aneurysm, presented with New York Heart Association class IV dyspnoea, echocardiography showed large left ventricular aneurysm with dyskinesia, large apical ventricular septal defect, ejection fraction 30%, coronary angiography: Proximal Left Anterior Decending artery (LAD) lesion 90%, Circumflex lesion 80%. There was one aneurysm of the left ventricle. The aneurysm was to the left of the left anterior descending coronary artery. The left ventricle was opened through the aneurysm. The ventricular septal defect was situated anteriorly in the apical region of the septum. The overall area was about 3 cm(2). It was closed with a dacron patch. The aneurysm was removed and closed with felts of Teflon. Saphenous vein grafts were inserted into the circumflex (obtuse marginal 1) and left anterior decending artery. Postoperatively no murmur was audible. Sinus rhythm was retained. Digoxin and diuretic therapy were continued and the patient was discharged from hospital 7 days after operation. A follow up echocardiographic study was done and that showed left ventricular dialatation, wall motion abnormality with moderate systolic dysfunction, no shunt across the ventricular septum, no pulmonary arterial hypertension, with ejection fraction of 35%. She remained well until 18 months after operation.