PMC8283223_01
Twelve-lead electrocardiography at presentation. A 12-lead electrocardiogram shows ST elevation in inferior leads (II, III, AVF) with reciprocal ST depressions in lateral leads (I, AVL, V4-V6).
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Electrocardiogram demonstrated ST-segment elevations in the inferior leads (Figure 1).
Angiography of right coronary artery (RCA) in left anterior oblique projection. It demonstrates complete occlusion of the mid vessel with the reconstitution of distal RCA from right to right collaterals.
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He then underwent emergent coronary angiography, which divulged severe multi-vessel coronary artery disease, with complete occlusion of mid-right coronary artery (Figure 2; Supplementary Videos 1 and 2, available online).
Left ventriculogram. Left ventriculogram in anterior oblique (RAO) projection demonstrating an inferobasal wall true aneurysm.
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Left ventriculography revealed inferior wall hypokinesis of left ventricle with basilar inferior segment aneurysm and mural thrombus (Figure 3; Supplementary Video 3, available online).
Cardiac magnetic resonance (CMR) imaging. CMR imaging in sagittal view (2-chamber view) demonstrating left ventricular true aneurysm.
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It showed a wide-mouthed aneurysm in the base of the inferior wall, measuring 5.2 x 5.3 x 4.4 cm with an associated mural thrombus (Figure 4).
Cardiac magnetic resonance (CMR) imaging. Short-axis view of heart on CMR imaging showing ventricular septal rupture at inferobasal left ventricle.
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Table 2). Transmural delayed enhancement, involving mid and basal inferior septum, was suggestive of nonviable myocardium (Figure 5).
The step-wise approach to the aneurysmectomy procedure. LVA, left ventricular aneurysm; PP, polypropylene; IVMS, interrupted vertical mattress sutures; IMS, interrupted mattress sutures.
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The step-wise approach to the aneurysmectomy procedure is outlined in the flowchart (Figure 6).