LV aneurysm – left ventriculogram

Left ventricular aneurysm

This still picture from a left ventricular angiogram shows a bulge in the anterolateral region of the left ventricle in systole suggestive of an aneurysm. A true aneurysm is composed of all three layers of the heart, namely endocardium, myocardium and pericardium. It has a wide neck and is very unlikely to rupture. In contrast, a pseudo aneurysm is a ventricular rupture sealed off by the pericardium. It has a narrow neck and has a high risk of secondary rupture. A true aneurysm can cause arrhythmias due to the viable tissue in the oorder zone with varying refractory periods which can cause re-entrant arrhythmias. It can also lead to refractory heart failure due to wasted systole – i.e., a portion of the ventricular blood moves in and out of the aneurysm without being pumped out into the aorta.

Left coronary angiogram showing near total occlusion of LAD

The region of the aneurysm is usually the territory of a poorly collateralised total or near total coronary occlusion. In this case it is near total occlusion of the left anterior descending coronary artery beyond a major diagonal with faint anterograde flow (blue arrows)