A growing left ventricular aneurysm after myocardial infarction: pathological confirmation of subepicardial aneurysm

Excerpt

A 67-year-old woman with a history of hypertension, diabetes mellitus, surgical treatment of colon and cervical cancers, and recent cerebral infarction, who complained of epigastralgia lasting 3 days, was admitted due to inferior myocardial infarction. She received successful percutaneous coronary interventions for her occluded right coronary artery with thrombus followed by intracoronary administration of tissue plasminogen activator (TPA). The door to balloon time was 140 min, and her final angiogram indicated TIMI 3 reflow. Although her hemodynamic condition was stabilized without arrhythmic events during the hospitalization except for one sustained ventricular tachycardia event, which was successfully treated by cardioversion, she started to suffer aspiration pneumonia. Serial routine follow-up echocardiograms found a growing left ventricular aneurysm in her infarcted myocardium (Fig. 1a). She refused any further surgical intervention, and passed away after 2 months’ hospitalization due to refractory respiratory infection. An autopsy was performed, and a large left ventricular aneurysm (70 × 50 mm) with aneurysmal neck (Fig. 1b) was observed macroscopically. Microscopically, the aneurysmal wall did not involve the parietal pericardium with hematoxylin–eosin stain (Fig. 1c, upper). A mural thrombus was also detected (TH). An immunological stain with desmin (Fig. 1c, lower) further revealed a thin layer of myocardium (arrow heads). These findings were consistent with a diagnosis of left ventricular subepicardial aneurysm (SEA).

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