PMC5308434_01
(a) ECG shows Q wave in leads III and AVF, negative T waves DII, DIII and AVF, and ST-T abnormalities in V5-V6. 2D and Color Doppler echo images of (b) akinesia, thinning and rupture of LV infero-lateral wall; (c) LV to pericardium cross-over blood shunt through defects; and (d) massive thrombosis of cavity and inferolateral wall.
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ECG showed signs of old inferior wall MI and lateral wall ST-T abnormalities (Figure 1(a)). Her echo displayed LV dilatation ((left ventricular end-diastolic dimension (LVEDD), 7.6 cm; left ventricular end-systolic dimension (LVESD), 6.0 cm)), reduced left ventricular ejection fraction (LVEF, 35%), moderate mitral regurgitation, hypo-akinesia and thinning (0.6 mm) of LV infero-lateral wall with rupture and cross-over blood shunt through two defects into pericardium (Figure 1(b) and (c)) and thrombi (Figure 1(d)).
Intraoperative views of (a) pulsating mass 15-10 cm in size at postero-diaphragmatic wall of LV; (b, c) organized and epithelialized content of the aneurysmatic sac and LV wall; and (d) postoperative echo image of LV after resection of sac and repair of defect.
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During operation, we revealed pulsating mass along LV postero-diaphragmatic wall (Figure 2(a)). Its cavity was filled and LV walls were covered by densely organized and epithelialized tissue (Figure 2(b) and (c)). Her echo after operation (Figure 2(d)) revealed reduction in LV size (LVEDD, 6.2 cm and LVESD, 4.7 cm), increase in LVEF (46%) and mild mitral regurgitation.