case_images: PMC11719635_01
case_images: Preoperative echocardiography: large LV aneurysm below the posterior mitral valve leaflet tethering it open in systole resulting in severe functional mitral regurgitation.
case_images: rjae845f1.jpg
case_images: PMC11719635_01_rjae845f1.jpg
case_images: f1
case_images: Echocardiography (Fig. 1) and cardiac magnetic resonance imaging revealed a dilated LV [left ventricular ejection fraction (LVEF) of 25%] and a large aneurysm (9.3 x 9.5 cm) involving the basal mid-inferoseptum and basal inferolateral wall with evidence of thrombus.
case_images: The LV aneurysm was resected down to its neck into healthy ventricular scar tissue. The posterior chordae can be seen from the ventricular defect.
case_images: rjae845f2.jpg
case_images: PMC11719635_01_rjae845f2.jpg
case_images: f2
case_images: The aneurysm was resected (Fig. 2), and the LV wall repaired with a 5 x 3 cm patch, restoring normal LV size (Fig. 3).
case_images: Once the sutures for the patch were placed, the two papillary muscles were identified and another pledgeted suture through the musculotendinous junction was used to approximate them.
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case_images: PMC11719635_01_rjae845f4.jpg
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case_images: The musculotendinous junctions of the anterior and posterior papillary muscles were approximated using pledgeted 3-0 polypropylene sutures (Fig. 4).
case_images: A: The patch was parachuted down and secured. B: Following this the aneurysm sac was closed over the patch for added haemostasis.
case_images: rjae845f5.jpg
case_images: PMC11719635_01_rjae845f5.jpg
case_images: f5
case_images: The patch repair was completed (Fig. 5), and the overlying sac oversewn for haemostasis.
case_images: Postoperative echocardiography: restoration of mitral valve leaflet coaptation and LV geometry, resulting in trivial regurgitant jet.
case_images: rjae845f6.jpg
case_images: PMC11719635_01_rjae845f6.jpg
case_images: f6
case_images: Postoperative echocardiography (Fig. 6) revealed LV improvement (LVEF 45%) with a competent MV (trace regurgitation, no stenosis).