Clinical Characteristics of Postinfarction Left Ventricular Aneurysm with Extensive Calcification

The authors experienced 4 cases of calcified postinfarction aneurysm of the left ventricle. They were all male, aged 55 to 71 (mean 64). Risk factor for coronary artery disease was only smoking in 2 patients, but there was none in the others. They had had acute anteroseptal or extensive anterior infarction at age 41-57 years (mean 49.3), and associated major cardiac events 10-22 years (mean 14.5) after acute myocardial infarction. Ventricular tachycardia, congestive heart failure and systemic thromboembolism were seen in 4, 2 and 1 patients respectively. However, none developed angina pectoris. In the 2 patients in whom signal-averaged electrocardiogram was performed, late potential was detected, so it was suspected that ventricular tachycardia could be due to reentry. Left ventricular end-diastolic pressure was elevated in all patients except one and ranged from 11 to 22mmHg. Left ventricle was dilated in all cases and the end-diastolic volume index ranged from 143 to 503ml/m2. The left ventricular ejection fraction ranged from 11 to 24%. However, in 2 of the 4 patients, the cardiac index was within normal limits, and evidence of congestive heart failure was absent. In 2 other patients with associated congestive heart failure, cardiac indices were 2.32, 1.56l/min/m2 respectively. Coronary arteriogram showed a total occlusion in the left anterior descending (LAD) artery in all cases, and only the LAD artery was affected in 2 patients. In the remaining 2 patients, the right coronary arteries also were significantly stenotic or totally occluded, i.e., they had 2-vessel disease. One of 4 patients underwent an emergency aneurysmectomy of the left ventricle because of refractory ventricular tachycardia, which disappeared after the operation. To our knowledge, this is the first case of calcified postinfarction aneurysm associated with lethal ventricular arrhythmia following a successful operation. One died suddenly during fishing, and the another one died of pneumonia about 10 days after ventricular tachycardia with a shock. Moreover, the remainder died of septic shock complicated by pneumonia.