Coronary Artery Disease with LV Aneurysm

Author: Andrea Vitello; Nahush Mokadam, MD
Institution: University of Washington
Date Reviewed: February 2014
Learning Domain: Adult Cardiac Surgery
Learning Objective: Unusual LV Aneurysm after PCI
PowerPoint File: Coronary Artery Disease with LV Aneurysm

Early Discussion Points

• Timing of Presentation
• Initial management of acute STEMI
• Initial interpretation of Coronary Angiograms
• Therapeutic options
  • Medical Management because late after infarct
  • Percutaneous intervention - Diagonal, LAD, both?
  • Surgical approach

Discussion Points for Conference

• Was initial management optimal?
• Should LAD have been opened?
• Was follow up appropriate?
• Pathophysiology of LV aneurysm development?
• How does this case fit into Surgical Ventricular Restoration data? STITCH trial?
• Options now?
  • What is appropriate therapy for a mildly symptomatic patient with progressive LV dilation and known multivessel CAD?
  • Is aneurysmectomy +/- CABG going to be beneficial?

Learning Points

• Somewhat Unusual LV Aneurysm development
• Somewhat Unusual Location to LV Aneurysm
• Patient may have done better with early complete revascularization
• Cardiac Imaging becoming more sophisticated
• STITCH trial probably does not apply to this case
• Localized Aneurysm