Surgical management of patient with left ventricular aneurysm and ventricular tachycardia

Abstract

The management of patients with dilated cardiomyopathy and large anterior ventricular aneurysm presenting with ventricular tachycardia is not well-described. We report the case of 45-year-old male who presented with recurrent episodes of prolonged polymorphic ventricular tachycardia and previously failed medical management and endocardial and epicardial transcatheter ablation. We performed a Dor procedure to exclude the left ventricular aneurysm in conjunction with cryoablation to terminate his ventricular tachycardia. This surgical approach was found to be successful with conversion of the patient into normal sinus rhythm and restoration of the patient's left ventricular morphology and function. We also propose a methodology for the surgical management of patients with left ventricular aneurysm and intractable ventricular tachycardia focused on a discussion with the patient and the cardiac team about the options for treatment, including surgery or continuing pharmacological and electrical cardioversion therapy, choosing the surgical technique that would exclude the most diseased and akinetic myocardial segment, and being more liberal with the use of cryoablation.

Keywords: Left ventricular aneurysm; dilated cardiomyopathy; ventricular tachycardia.

Figure 1.

(a) Pre-operative computed tomography demonstrating a calcified left ventricle apical aneurysm (red arrow) in long axis, with a distance from the apex to the mitral valve of 11.5 cm in diastole. (b) Post-operative computed tomography of the heart showing the reconstructed left ventricle at 11 months following the Dor procedure, with a distance from the apex to the mitral valve of 9.0 cm in diastole.