PMC3466885_01
A) Left coronary angiogram in left anterior oblique (LAO) Caudal view showing LAD-D biforcation lesion and LCX 100% total cut-off (arrows). B) posteroanterior cranial view showing blocked RCA (arrow) LMC, Left main coronary artery; LAD, Left anterior descending artery; LCX, Left circumflex artery; D, Diagonal artery; RCA, Right coronary artery
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Coronary angiogram revealed severe triple vessel disease (Figure 1) and a large calcified posterobasal LV aneurysm.
MRI showing the posterobasal left ventricular aneurysm (arrows)
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Cardiac Magnetic Resonance Imaging (MRI) confirmed the anatomic findings of the posterobasal location (Figure 2).
A picture of PET scan showing viability of myocardium
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Positron Emission Tomography (PET) showed absence of viable myocardium in the left circumflex territory (LCX) and hibernating viable myocardium in the left anterior descending artery (LAD) and right coronary artery (RCA) territory (Figure 3).
Aneurysm showing thrombus (arrows)
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The aneurysm was dissected and exposed from the surrounding parietes before it was opened and the whole mural thrombus (Figure 4) was evacuated.
Mitral valve excised and replaced with #29 C.E. bioprosthesis via left ventricle (arrows)
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The mitral valve was excised and replaced through the ventricle with a # 29 Carpentier Edwards porcine bioprosthesis (Edwards Lifesciences, CA, USA) by interrupted pledgetted mattress 2.0 Ethibond sutures on the atrial side (Ethicon, Johnson & Johnson, Ltd.) (Figure 5).
Completed linear closure of ventriculotomy buttressed with Teflon strips (arrows)
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Teflon strips on either side utilizing interrupted mattress 3.0 Prolene (Ethicon, Johnson & Johnson, Ltd.) (Figure 6). The cardiopulmonary bypass was discontinued.