Post Myocardial Infarction Submitral Aneurysm Causing Stroke in an Elderly Patient- A Rare Case Report

Manish Ruhela^1, , Dinanath Kumar¹, Sarita Choudhary¹, Rajeev Bagarhatta¹ and Anoop Jain¹

¹Department of Cardiology, Sawai Man Singh Medical College & Hospital, Jaipur, Rajasthan, India

Cite this paper:
Manish Ruhela, Dinanath Kumar, Sarita Choudhary, Rajeev Bagarhatta and Anoop Jain. Post Myocardial Infarction Submitral Aneurysm Causing Stroke in an Elderly Patient- A Rare Case Report. American Journal of Medical Case Reports. 2015; 3(1):23-26. doi: 10.12691/ajmcr-3-1-9

Abstract

Left ventricular aneurysms are a frequent and serious complication following acute myocardial infarction and are most commonly located at the ventricular apex. The majority of these patients presents with severe mitral insufficiency, congestive heart failure, systemic embolism and sudden cardiac death. Giant aneurysms occurring in a submitral position between anterior and posterior papillary muscles on the lateral ventricular wall constitute a minor entity and those leaving the mitral apparatus intact are extremely rare. Herein, we report the case of a 70 years old male patient with a past history of inferior wall myocardial infarction 1 year back, now presented with right hemiparesis due to cardio-embolic stroke caused by thombus present in submitral left ventricular aneurysm. Despite the size of the aneurysm and its close relationship to the posterior mitral annulus the mitral apparatus was intact with a competent valve and normal left atrial size. To the best of our knowledge there are only few case reports in the literature where a patient develops large submitral LV aneurysm after myocardial infarction.

Keywords:
submitral aneurysm post myocardial infarction thrombus stroke

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Figures

References:

[1]	Cooley DA, Collins HA, Morris GC Jr, Chapman DW: Ventricular aneurysm after myocardial infarction; surgical excision with use of temporary cardiopulmonary bypass. J Am Med Assoc 1958, 167(5): 557-560.
[2]	Tikiz H, Atak R, Balbay Y, Genc Y, Kutuk E: Left ventricular aneurysm formation after anterior myocardial infarction: clinical and angiographic determinants in 809 patients. Int J Cardiol 2002, 82(1): 7-14. Discussion 6.
[3]	Cooley DA: Ventricular aneurysm after myocardial infarction: surgical excision with use of temporary cardiopulmonary bypass. Ann Thorac Surg 1988, 46(5): 589.
[4]	Arslan S, Gurlertop HY, Erol MK, Gundogdu F, Senocak H: Inferolateral left ventricular aneurysm preventing mitral regurgitation. Texas Heart Institute journal/ from the Texas Heart Institute of St Luke's Episcopal Hospital, Texas Children's Hospital 2007, 34(1): 130-131.
[5]	Abrams DL, Edelist A, Luria MH, Miller AJ: Ventricular aneurysm. A reappraisal based on a study of sixty-five consecutive autopsied cases. Circulation 1963, 27: 164-169.
[6]	Rittenhouse E. A, Sauvage L.R, Mansfield P.B, Smith J.C, Davis C.C, Hall D.G; False aneurysm of the left ventricle. Report of four cases and review of surgical management. Ann. Surg. 189 1979: 409-415.
[7]	Chesler E, Joffe N, Schamroth L, Meyers A: Annular subvalvular left ventricular aneurysms in the south african bantu. Circulation 1965, 32: 43-51.
[8]	Oyedeji AT, Lee C, Owojori OO, Ajegbomogun OJ, Akintunde AA: Successful medical management of a left ventricular thrombus and aneurysm following failed thrombolysis in myocardial infarction. Clin Med Insights Cardiol 2013, 7: 35-41.
[9]	Miura M, Fukuju T, Shibata M, Katahira Y: Surgical management of localized left ventricular aneurysm associated with acute myocarditis. Jpn J Thorac Cardiovasc Surg 2003, 51(6): 249-252.
[10]	Hasnain JU, Fiocco M, McLaughlin JS: Case report: management of left ventricular aneurysm and an intraventricular mass using perioperative transesophageal echocardiography. Md Med J 1995, 44(5): 369-371.
[11]	Athanasuleas CL, Buckberg GD, Menicanti L, Gharib M, Group R: Optimizing ventricular shape in anterior restoration. Semin Thorac Cardiovasc Surg 2001, 13(4): 459-467.
[12]	Athanasuleas CL, Stanley AW, Buckberg GD, et al: Surgical anterior ventricular endocardial restoration (SAVER) for dilated ischemic cardiomyopathy. Semin Thorac Cardiovasc Surg 2001, 13(4): 448-458.
[13]	Cooper GN Jr: Left ventricular remodeling or restoration for congestive heart failure. Med Health R I 2006, 89(1): 36-38.
[14]	Maxey TS, Reece TB, Ellman PI, et al: Coronary artery bypass with ventricular restoration is superior to coronary artery bypass alone in patients with ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2004, 127(2): 428-434.