Case Report: A case of giant left ventricular aneurysm resulting in LAD compression and stenosis.

We present the case of a 67-year-old male smoker who developed progressive heart failure despite successful primary PCI for an acute extensive anterior ST-elevation myocardial infarction. Initial echocardiography revealed an apical left ventricular aneurysm (LVA). Readmission 40 days later showed dramatic ventricular dilation, severely reduced LVEF (19%), and a large inferoapical aneurysm. Multimodality imaging was pivotal: repeat angiography demonstrated a new dynamic mid-LAD stenosis; IVUS confirmed extrinsic luminal compression without plaque; CMR and nuclear scintigraphy quantified extensive scar (69% of LV). This comprehensive workup excluded conventional causes and established a diagnosis of external mechanical compression of the mid-LAD by the expanding giant LVA, creating a vicious cycle of ischemia and remodeling. This case underscores that an LVA is not merely a passive scar but can be a dynamically disruptive entity. It highlights the critical role of advanced imaging in diagnosing this rare complication and illustrates the therapeutic dilemma when definitive surgery is declined.