A Case of Endoventricular Circular Patch Plasty for Postinfarction Akinetic Aneurysm of Left Ventricle, Associated with Severe Pulmonary Hypertension and Sustained Ventricular Tachycardia

Abstract

Endoventricular circular patch plasty was performed in a 42-year-old man, with a postinfarction akinetic aneurysm. The case was complicated with severe congestive heart failure, marked pulmonary hypertension (70% of systemic pressure) and sustained ventricular tachycardia. Cardiac catheterization data revealed low ejection fraction (20%), high pulmonary capillary wedge pressure (33mmHg) and high pulmonary arterial pressure (70/33mmHg), associated with enlarged end diastolic volume index (142ml/m²). After the operation, contractile and volumetric improvements were observed, however the severe pulmonary hypertension remained without any improvement. Disappearance of life-threatening arrhythmia allowed his discharge from the hospital, but unsatisfactory hemodynamic data, except for improved ejection fraction to 49%, turned our attention to patient selection and alternative treatment (cardiac transplantation) for such a severe case.