PMC5875140_01
The 12-lead electrocardiogram shows ST elevation, contextual Q waves and negative T waves in inferior leads (DII, DIII, aVF) and ST depression in V2-V6
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F1
The ECG showed a ST segment elevation and Q waves in the inferior leads in association with ST-segment depression in V2-V6 [Figure 1].
Preoperative transthoracic echocardiography. Apical two-chamber view shows the midbasal inferior left ventricular aneurysm (a and b). Subcostal views show the ventricular septal rupture (c) and the left to right ventricular shunt (d)
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F2
Intraoperative transesophageal echocardiography shows the ventricular septal rupture (a) and the shunt between the two ventricles (b). Intraoperative findings shows ovalar septal rupture (c) and closure of ventriculotomy (d)
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F3
Intraoperative findings confirmed the interventricular septal rupture and huge inferior left ventricular aneurysm [Figure 3].
Left ventriculography shows the huge inferior left ventricular aneurysm (An) and the contrast enhanced in the right ventricle (arrow)
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F4
It confirms the huge left ventricular aneurysm of about 6.5 cm x 6 cm with a 3.5 cm neck, with contrast enhanced in the right ventricle and opacification of trabeculae carneae of the moderator band, indirect sign of the interventricular septal rupture [Figure 4].
Postoperative transesophageal echocardiography. Transgastric view shows the neoleft ventricular cavity (a) and the absence of residual shunt (b). Three-dimensional echocardiography shows the correct apposition of the patch and the excluded portion of the infarcted interventricular septum (c and d)
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F5
Postoperative TEE showed a reduced size of the defect, secondary to a lowering in strain forces, indirect sign of good performance of the patch, and good systolic function of both ventricles; on performing the 3D echocardiography, we were able to locate the good placing of the patch, which was well adherent to the interventricular septum; moreover, no residual shunt was observed by the Color Doppler analysis [Figure 5].