Left Ventricular Aneurysm

1. Coronary artery disease and myocardial infarction is the cause in 95% of cases.
2. Trauma or injuries.
3. Sarcoidosis.
4. Congenital heart problem in which the ventricle has small saca since birth that grows into aneurysm

How it develops?

After a heart attack due to myocardial infarction, an area of the left ventricle muscle will be deprived of blood and becomes dead. Within hours of infarction this area becomes thinned out. Within a few days, it becomes smooth with deposition of fibrin and thrombus within the dead muscle. Inflammatory cells then migrate to this area and start dissolving and eating dead muscle cells. Loss of contraction in the large dead zone and preserved contraction of surrounding normal muscle cause bulging and thinning of this dead area. 4 weeks after infarction, when highly vascularized  granulation tissue (tissue characterized by rich content of blood vessels) appears. This granulation tissue is subsequently replaced by fibrous (scar) tissue 8 weeks after infarction. Ventricular wall thickness decreases as the dead muscle becomes largely replaced by this scar tissue.  Arrhythmias such as ventricular tachycardia may occur at any time during the development of ventricular aneurysm.

Symptoms

1. Angina or chest pain is the most frequent symptom.
2. Shortness of breath is the second most common symptom of ventricular aneurysm.
3. Atrial or ventricular arrhythmias may produce palpitations, fainting, or sudden death, or aggravate chest pain and shortness of breath in up to one third of patients.
4. Thromboembolism may occur and can lead to of stroke or limb ischemia.

Diagnosis

1. The electrocardiogram frequently demonstrates electrical changes of previous myocardial infarction.
2. The chest radiograph may show left ventricular enlargement and enlarged heart.
3. Left ventriculography which involve injection of a dye and filming your heart is the gold standard for diagnosis of left ventricular aneurysm.
4. Echocardiography is also specific means of diagnosing left ventricular aneurysm. It can also detect a thrombus inside your left ventricle as well as mitral incompetence.

Surgical treatment

Operation is indicated for symptomatic patients, and offers better outcome than medical therapy.

Removing a left ventricular aneurysm requires using the heart-lung machine. Much of the scar tissue sac is removed, and the remaining heart muscle is repaired or sewn back together by using one of several techniques. Frequently when performing surgery to remove a left ventricular aneurysm, blocked coronary arteries are also bypassed. A patient who needs coronary bypass surgery may also happen to have a left ventricular aneurysm. In most cases, patients undergoing aneurysm removal, with or without additional coronary bypass grafting, have a good chance of surviving the operation usually in the range of 90 percent to 95 percent.