Urgent Cardiosurgical Treatment of a Military Servant with a Moving Thrombus in the Area of the Left Ventricular Apical Aneurysm (Case Report)

DOI: https://doi.org/10.30702/ujcvs/24.32(01)/GN005-7682
Keywords: serviceman, myocardial infarction, acute coronary syndrome, thrombosed left ventricular aneurysm, cardiac surgery, thrombectomy, echocardiography

Abstract

Against the background of military operations, post-traumatic stress disorder, the progression of the atherosclerotic process is observed, which can lead to myocardial infarction even in young people. Left ventricular aneurysm (LVA) in military personnel is the result of untimely revascularization of an infarct-related artery, gunshot wound to the heart, chest trauma, etc. The presence of a dyskinetic area promotes formation of blood clots in the LVA cavity. LVA thrombosis is associated with an increased risk of embolism, ischemic stroke, and death.

Case description. A 37-year-old military servant A. was urgently hospitalized to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a mobile thrombus in the area of LVA, size 4.5 x 3 cm, with signs of lysis and a threat of separation according to echo data. The patient was found to suffer Q-wave myocardial infarction 5 months ago; at the time of examination there was decompensation of the condition and a decrease in the left ventricular contractility to 34%. The patient underwent urgent operation: on-pump coronary artery bypass grafting, LVA resection with thrombectomy. The duration of the operation was 7 hours, the aortic cross-clamp time was 53 minutes, the perfusion time was 93 minutes, the blood loss was 500 ml. The postoperative period was uneventful. The patient was discharged on the 7th day with improvement, the ejection fraction was 40%.

Conclusion. The lack of an opportunity to conduct timely electrocardiography and echo for military personnel with acute chest pain reduces the chances of diagnosis and treatment of myocardial infarction within the therapeutic window, which leads to the occurrence of complicated forms of coronary heart disease, namely LVA. Echo is of crucial importance in deciding on emergency cardiac surgery for thrombosed LVA.

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Published
2024-03-27
How to Cite
1.
Gogayeva OK, Nudchenko OO, Malysheva TA, Shnaider LM, Tertychna AS, Stavinchuk VI, Rudenko SA. Urgent Cardiosurgical Treatment of a Military Servant with a Moving Thrombus in the Area of the Left Ventricular Apical Aneurysm (Case Report). ujcvs [Internet]. 2024Mar.27 [cited 2024Dec.22];32(1):76-2. Available from: https://cvs.org.ua/index.php/ujcvs/article/view/633
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 32 No 1 2024
Section
CARDIOVASCULAR SURGERY UNDER MARTIAL LAW

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