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.
). 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.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.
) 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.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.
). The patient was observed to be symptom-free during the next 12 months of follow-up.