Surgical treatment of postinfarction thrombosed left ventricle aneurysm formed from coronary artery dissection.

Background: Spontaneous coronary artery dissection (SCAD) may lead to acute myocardial infarction (MI), delayed treatment might develop such life-threatening complication as left ventricle aneurysm (LVA) with further embolization due to the presence of a thrombus in the aneurysmal sac. Material and methods: ECG, Echo, coronary angiography and cardiac surgery were performed to a 42-year-old military servant with episodes of dyspnea, dizziness and unconsciousness. Results: There were a signs of postinfarction LVA on ECG. Echo study confirmed LVA with moderate decrease of LV ejection fraction (EF) 35 % and floating thrombus. Coronary angio findings were as following: stenosis of LAD up to 50 %, LCX 60 % with spiral dissection of the LAD. We performed CABG, resection of LVA with thrombectomy on-pump. Patient was discharged on 8th postoperative day. In 15 months after surgery ECHO revealed a recurrent thrombosis of LV apex (LV EF 45 %) that is characterized by increased mobility and heterogeneous structure. Ultrasound exam of lower extremities arteries revealed two thrombotic occlusions: one of the right posterior tibial artery in the middle segment, and another of the left anterior tibial artery in the distal segment. Reoperation was performed on-pump (13 min fibrillation and 98 min perfusion time). Patient was discharged on 6th day after surgery. Conclusion: Our clinical case demonstrates successful surgical treatment of patient with thrombosed LVA, which appeared after MI due to the coronary artery dissection. Uncontrolled anticoagulation therapy was one of the reasons for recurrent LV thrombosis with low extremities arteries embolization which required on-pump redo cardiac surgery.