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.

References

  1. Paul M, Schäfers M, Grude M, Reinke F, Juergens KU, Fischbach R, et al. Idiopathic left ventricular aneurysm and sudden cardiac death in young adults. Europace. 2006;8(8):607-612. https://doi.org/10.1093/europace/eul074
  2. Wilinski MS, Porter IM. Idiopathic Left Ventricular Apical Aneurysm in a Sailor With Moderate Transient Chest Pain: A Unique Perspective on an Atypical Presentation in the Military Population. Mil Med. 2023;188(11-12):e3707-e3710. https://doi.org/10.1093/milmed/usac416
  3. Gogayeva O, Knishov G, Rudenko A, Dzakhoieva L, Rudenko S, Rudenko K. Aneurysm of left ventricle at non-atherosclerosis lesion of coronary arteries. J Cardiothorac Surg. 2015 Dec 16;10(Suppl 1):A154. https://doi.org/10.1186/1749-8090-10-S1-A154
  4. Borges-Pereira J, Coura JR, Zauza PL, Pirmez C, Xavier SS. Chagas disease in Virgem da Lapa, Minas Gerais, Brazil: left ventricle aneurysm and the risk of death in the 24-year interval. Mem Inst Oswaldo Cruz. 2020 Jun 12;115:e200056. https://doi.org/10.1590/0074-02760200056
  5. Magarakis M, Macias AE, Tompkins BA, Reis V, Loebe M, Batista R, et al. Cardiac surgery for Chagas disease. J Card Surg. 2018;33(10):597-602. https://doi.org/10.1111/jocs.13795
  6. Mouine N, Bennani R, Amri R. A giant left ventricular pseudoaneurysm in Behçet’s disease: a case report. Cardiol Young. 2014;24(2):382-383. https://doi.org/10.1017/S1047951113000498
  7. Helft G, Le Feuvre C, Wechsler B. Left ventricular aneurysm in Behçet’s disease. Arch Cardiovasc Dis. 2008 May;101(5):375. https://doi.org/10.1016/j.acvd.2008.04.004
  8. Campagnucci VP, Pinto e Silva AM, Catani LH, Rivetti LA. Recurrent Giant Left Ventricular Aneurysm of Tuberculous Etiology in a Child: Case Report. Heart Surg Forum. 2012;15(6):E318-E319. https://doi.org/10.1532/HSF98.20121030
  9. Shiba M, Kitano D, Kunimoto S, Hirayama A. Identification of left ventricular chamber-like aneurysm related to cardiac sarcoidosis. BMJ Case Rep. 2018 Jun 17;2018:bcr2017223910. https://doi.org/10.1136/bcr-2017-223910
  10. Hoff LS, Pimentel CQ, Faillace BLR, Rochitte CE, Demarchi LMMF, Bonfá E, et al. Left ventricular pseudoaneurysm associated with systemic lupus erythematosus. Lupus. 2019;28(5):681-684. https://doi.org/10.1177/0961203319837359
  11. Samuels LE, Spangler WD, Goel I. Surgical Resection of a Lupus-Related Left Ventricular Aneurysm in a Patient with Normal Coronary Arteries: Case Report. Heart Surg Forum. 2005;8(2):E75-E76. https://doi.org/10.1532/HSF98.20041151
  12. Challapudi G, Boyle GJ, Rodriguez ER, Komarlu R. Fetal Left Ventricular Apical Aneurysm Progressing to Dilated Cardiomyopathy Due to Glycogen Storage Disease. Tex Heart Inst J. 2022 Jul 1;49(4):e207364. https://doi.org/10.14503/THIJ-20-7364
  13. Toda G, Iliev II, Kawahara F, Hayano M, Yano K. Left Ventricular Aneurysm without Coronary Artery Disease, Incidence and Clinical Features: Clinical Analysis of 11 Cases. Intern Med. 2000;39(7):531-536. https://doi.org/10.2169/internalmedicine.39.531
  14. el Noor IB, Venugopalan P, Johnston WJ, Froude JR. Ventricular aneurysm and myocarditis in a child with the hyperimmunoglobulin E syndrome. Eur Heart J. 1995;16(5):714-715. https://doi.org/10.1093/oxfordjournals.eurheartj.a060980
  15. Shi T, Liu R, Zhang C, Guo S. Repair of traumatic ventricular septal defect and left ventricular aneurysm after blunt chest trauma. Interact Cardiovasc Thorac Surg. 2021;32(1):156-158. https://doi.org/10.1093/icvts/ivaa217
  16. Sakka SG, Hüttemann E, Reinhart K. Linksventrikuläres Aneurysma nach Myokardkontusion bei stumpfem Thoraxtrauma [Left ventricular aneurysm after myocardial contusion caused by blunt chest trauma]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2000;35(6):412-416. German. https://doi.org/10.1055/s-2000-7983
  17. Sapkota R, Koirala B. Traumatic pseudoaneurysm of the heart. Gen Thorac Cardiovasc Surg. 2016;64(2):101-104. https://doi.org/10.1007/s11748-014-0391-0
  18. Gogayeva OK, Rudenko ML, Nudchenko OO. [The Occurrence of Thrombotic Complications Due to Combat Trauma Against the Background of the COVID-19 Pandemic]. Ukrainian Journal of Cardiovascular Surgery. 2022;30(4):115-121. Ukrainian. https://doi.org/10.30702/ujcvs/22.30(04)/GR058-115121
  19. Solaković E, Pasić M. Pseudoaneurizma lijevog ventrikula u podrucju zadnjeg zida sa perforacijom lijevog ventrikula nastala nakon ranjavanja projektilom ispaljenim iz vatrenog oruzja [Pseudoaneurysm in the posterior wall of the left ventricle with perforation of the left ventricle due to a firearm injury]. Med Arh. 2004;58(2):125-126. Bosnian.
  20. Crane AP. Traumatic Rupture of the Myocardium: Report of Three Cases. Mil Surg. 1952;110(5):346-349. https://doi.org/10.1093/milmed/110.5.346
  21. Crum-Cianflone NF, Bagnell ME, Schaller E, Boyko EJ, Smith B, Maynard C, et al. Impact of Combat Deployment and Posttraumatic Stress Disorder on Newly Reported Coronary Heart Disease Among US Active Duty and Reserve Forces. Circulation. 2014;129(18):1813-1820. https://doi.org/10.1161/CIRCULATIONAHA.113.005407
  22. Lorem GF, Næss ET, Løchen ML, Lillevoll K, Molund EM, Rösner A, et al. Post-traumatic stress disorder among heart disease patients: a clinical follow-up of individuals with myocardial infarction in the Tromsø Study. BMC Psychiatry. 2023 Dec 12;23(1):936. https://doi.org/10.1186/s12888-023-05431-2
  23. Pedersen SS, Middel B, Larsen ML. Posttraumatic stress disorder in first-time myocardial infarction patients. Heart Lung. 2003;32(5):300-307. https://doi.org/10.1016/s0147-9563(03)00097-9
  24. Ebrahimi R, Dennis PA, Shroyer ALW, Tseng C-H, Alvarez CA, Beckham JC, et al. Pathways Linking Post-Traumatic Stress Disorder to Incident Ischemic Heart Disease in Women: Call to Action. JACC Adv. 2024;3(1):100744. https://doi.org/10.1016/j.jacadv.2023.100744
  25. McGraw LK, Turner BS, Stotts NA, Dracup KA. Acute Coronary Syndromes in Deployed Military Personnel. J Am Acad Nurse Pract. 2011;23(8):427-433. https://doi.org/10.1111/j.1745-7599.2011.00624.x
  26. Cruz Rodriguez JB, Okajima K, Greenberg BH. Management of left ventricular thrombus: a narrative review. Ann Transl Med. 2021 Mar;9(6):520. https://doi.org/10.21037/atm-20-7839
  27. Smith B, Ryan MA, Wingard DL, Patterson TL, Slymen DJ, Macera CA; Millennium Cohort Study Team. Cigarette Smoking and Military Deployment: A Prospective Evaluation. Am J Prev Med. 2008;35(6):539-546. https://doi.org/10.1016/j.amepre.2008.07.009
Published
2024-03-27
How to Cite
Gogayeva, O. K., Nudchenko, O. O., Malysheva, T. A., Shnaider, L. M., Tertychna, A. S., Stavinchuk, V. I., & Rudenko, S. A. (2024). Urgent Cardiosurgical Treatment of a Military Servant with a Moving Thrombus in the Area of the Left Ventricular Apical Aneurysm (Case Report). Ukrainian Journal of Cardiovascular Surgery, 32(1), 76-82. https://doi.org/10.30702/ujcvs/24.32(01)/GN005-7682
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 32 No 1 2024
Section
CARDIOVASCULAR SURGERY UNDER MARTIAL LAW