Giant Thrombosed Left Ventricular Aneurysm Revealed by Sustained Ventricular Tachycardia: A Case Report
S. Oudadda *
Department of Cardiology, Faculty of Medicine and Pharmacy, Arrazi Hospital, Mohammed VI University Hospital Center Marrakech, Cadi Ayyad University, Marrakech, Morocco.
N. Bellaji
Department of Cardiology, Faculty of Medicine and Pharmacy, Arrazi Hospital, Mohammed VI University Hospital Center Marrakech, Cadi Ayyad University, Marrakech, Morocco.
K. Elaakib
Department of Cardiology, Faculty of Medicine and Pharmacy, Arrazi Hospital, Mohammed VI University Hospital Center Marrakech, Cadi Ayyad University, Marrakech, Morocco.
J. El Masrioui
Department of Cardiology, Faculty of Medicine and Pharmacy, Arrazi Hospital, Mohammed VI University Hospital Center Marrakech, Cadi Ayyad University, Marrakech, Morocco.
S. El Karimi
Department of Cardiology, Faculty of Medicine and Pharmacy, Arrazi Hospital, Mohammed VI University Hospital Center Marrakech, Cadi Ayyad University, Marrakech, Morocco.
M. EL Hattaoui
Department of Cardiology, Faculty of Medicine and Pharmacy, Arrazi Hospital, Mohammed VI University Hospital Center Marrakech, Cadi Ayyad University, Marrakech, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Giant post-infarction left ventricular aneurysms associated with extensive calcification and massive mural thrombus are rare and pose significant diagnostic and therapeutic challenges.
We report the case of a 72-year-old patient with ischaemic cardiomyopathy and severe left ventricular systolic dysfunction who presented with advanced heart failure symptoms and sustained ventricular tachycardia, successfully terminated with amiodarone. Transthoracic echocardiography and computed tomography angiography revealed a giant, calcified left ventricular aneurysm measuring 92 × 65 × 120 mm and containing a massive organised mural thrombus, associated with severe biventricular dysfunction and a left ventricular ejection fraction of approximately 20%. Following multidisciplinary Heart Team assessment, surgical intervention was considered excessively high risk. Management focused on optimised heart failure therapy and anticoagulation for the left ventricular thrombus, while an implantable cardioverter-defibrillator was considered for secondary prevention of sudden cardiac death. This case highlights the complementary role of echocardiography and computed tomography angiography in characterising aneurysm morphology, calcification, and intracavitary thrombus. It also underscores the complexity of balancing thromboembolic and arrhythmic risks against operative risk in patients with advanced ischaemic heart disease. A multidisciplinary approach and individualised therapeutic strategy are essential when surgical treatment is not feasible.
Keywords: Left ventricular aneurysm, mural thrombus, ventricular tachycardia, ischaemic cardiomyopathy