PMC10279483_01
Imaging of the (
A
) left ventricle aneurysm (white arrow: left anterior descending, red arrow: aneurysm). (
C
) Coronary angiograph, (
B
) three-dimensional computed tomography scan, (
D
) magnetic resonance imaging scan.
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Further workup included a coronary angiography, which showed a, most likely, ruptured, nonstenosing LAD plaque and cardiac magnetic resonance imaging, which revealed an aneurysm of the base of the anterior ventricular wall (see Fig. 1 ). 
(
A-F
) Surgical setup.
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The area of the aneurysm, a protrusion in the left ventricular wall between LAD and first diagonal branch with scarred margins, was easily identified by palpation (see Fig. 2A , black arrow). An incision was made and the affected area was resected (see Fig. 2B ), with care taken to avoid injury to the LAD. The atrium and ventricle were not dilated (38 and 50 mm, respectively, on echocardiography) and therefore the ventriculotomy was closed with a 5 x 2cm (visual judgement) bovine pericardial patch with single 3-0 Prolene sutures reinforced by felt strips (see Fig. 2C, D ) without using any glue. The course of the LAD was carefully dissected to avoid putting stress on the myocardium and causing stenosis (see Fig. 2E , F , black arrow).