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Tex Heart Inst J. 2005; 32(4): 614–615.
PMCID: PMC1351847

Left Ventricular Aneurysm ina 4-Year-Old Boy

A 4-year-old boy with a history of acute lymphoblastic leukemia was referred for evaluation of cardiac function due to progressive decline in exercise tolerance and to cardiomegaly on chest radiography. Six months earlier, there had been no such finding on the chest film. Echocardiography, also performed at the earlier visit, had yielded a normal result.

Echocardiography now showed severe left ventricular dysfunction. In addition, a parasternal long-axis view revealed a large aneurysmal sac, estimated to be 8 × 6 cm, in the apical wall of the left ventricle (Fig. 1). The aneurysm's wall was much thinner than a normal left ventricular wall. Because the thin tissue posed a risk of perforation, and because echocardiography was enough for diagnosis, we did not perform angiography. The patient was started on anticoagulation therapy due to the risk of thromboemboli and was given medication for left ventricular systolic dysfunction, in preparation for elective surgery.

figure 35FF1
Fig. 1 Echocardiography revealed a large aneurysmal sac, estimated to be 8 × 6 cm, in the apical wall of the left ventricle.

The operation was performed through a median sternotomy with use of cardiopulmonary bypass and aortic cross-clamping. At operation, the left ventricle was seen to be dilated and the left ventricular wall to have a thin myocardial outpouching (Fig. 2) near the apex. Aneurysmectomy was performed, after which the ventriculotomy was closed with a knitted Dacron patch using running suture (Fig. 3). The morphology of the aneurysm's sac was elastic, its thickness was 2 mm, and its internal surface was covered by thrombus.

figure 35FF2
Fig. 2 At operation, the left ventricle was dilated and, near the apex, was aneurysmal, with a thin outpouching that measured 8 × 6 × 4 cm.
figure 35FF3
Fig. 3 Aneurysmectomy was performed, and the ventriculotomy was closed with a knitted Dacron patch, by means of running suture.

The patient made an uneventful recovery and was discharged from the hospital on postoperative day 7. Histologic examination of the material obtained during operation showed nonspecific inflammation. Echocardiography 1 month after the operation showed no residual aneurysm and partial improvement in left ventricular function (Fig. 4). The patient was observed to be symptom-free during the next 12 months of follow-up.

figure 35FF4
Fig. 4 Echocardiography 1 month after the operation showed no residual aneurysm and partial improvement in left ventricular function.

Comment

Cardiac ventricular aneurysms are rare in the pediatric population. These aneurysms are multifactorial in origin. Left ventricular aneurysms can be congenital or acquired. The acquired form may be caused by trauma, myocardial infarction, infection, and cardiac surgery.1,2 The congenital form probably is caused by endocardial fibroelastosis, myocarditis, and ischemic myocardial injury during the fetal period.3

Due to the rarity of the disease, its natural history has not been clarified. Sixty percent of patients are symptomatic, and most of those eventually develop heart failure. Other, less common sequelae are thrombosis, coronary insufficiency, cardiac rupture, arrhythmias, subacute bacterial endocarditis, angina, and sudden death.4,5

We speculate that the aneurysm in our patient developed during the prior 6 months, secondary to an infection or ischemia. Histologic examination of the material was not helpful, but we believe that this was an acquired lesion.

Footnotes

Address for reprints: Dr. Abdulkadir Ercan, Uludag University Medical Faculty, Department of Cardiovascular Surgery, Gorukle, 16059 Bursa, Turkey

E-mail: moc.oohay@nacreridak

References

1. Veeragandham RS, Backer CL, Mavroudis C, Wilson AD. Traumatic left ventricular aneurysm and tricuspid insufficiency in a child. Ann Thorac Surg 1998;66:247–8. [PubMed]
2. Weesner KM, Byrum C, Rosenthal A. Left ventricular aneurysms associated with intraoperative venting of the cardiac apex in children. Am Heart J 1981;101:622–5. [PubMed]
3. Gerlis LM, Partridge JB, Fiddler GI, Williams G, Scott O. Two chambered left ventricle: three new varieties. Br Heart J 1981;46:278–84. [PMC free article] [PubMed]
4. Meyer BJ, Amann FW, Jenni R, Bertel O, von Segesser LK, Turina M. Malignant ventricular arrhythmia in congenital aneurysms of the left ventricle in adulthood. Helv Chir Acta 1992;58:479–83. [PubMed]
5. Hamaoka K, Onaka M, Tanaka T, Onouchi Z. Congenital ventricular aneurysm and diverticulum in children. Pediatr Cardiol 1987;8:169–75. [PubMed]

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