Patient (54 yrs/Female) had a MI and presented with postMI angina on 27.07.2015
•CAG revealed MVD and patient went through CABG on 03.08.2015
•Patient readmitted with newly developed chest discomfort on 03.02.2016
•CAG revealed LIMA-> LAD occluded. Asub-mitral aneurysm was noted.
•PTCA was done and LAD was stented on 05.02.2016.
•Patient still had persistent symptom (with preserved EF) in spite of maximum medical management.
•Cardiac MRI was advised on 28.11.2019.
MRI on 05/12/2019:
Indication: Inferior Wall Aneurysm.
Finding: LVEF-56%, No LVOT obstruction.
An aneurysm of size 3.2 x 2.5 x 2.4 cm with neck size is seen arising from basal & mid inferior wall. The RV is Normal with preserved systolic function.
Normal atrial diameter. No LV thrombus.
Lungs and mediastinum are within normal limits. MRI 01.wmv MRI 02.wmv MRI 03.wmv
Conclusion:There is significant discrepancy in sizes via various imaging modalities, which makes sizing challenging.Tiding over this problem by oversizing may not be feasible as the disc on ventricular side may impinge on mitral leaflets/ subvalvular apparatus.Sizing also involves assessment of depth of aneurysm.Mostly ASD closure devices are appropriate choices.