A left ventricular submitral aneurysm is a rare cardiac abnormality where the left ventricle bulges outward beneath the mitral valve annulus, often in association with congenital defects or acquired conditions like inflammation or infection. It can lead to mitral regurgitation and other complications, including heart failure and ventricular arrhythmias
Definition: A left ventricular (LV) submitral aneurysm is a localized bulge or outpouching of the left ventricular wall located directly beneath the mitral valve, specifically at the area where the posterior mitral valve leaflet attaches to the mitral annulus.
Causes
Congenital Acquired
A 80-year-old female presented with a history of progressive breathlessness of 2- month duration with Resting electrocardiogram (ECG) showed sinus rhythm with low-voltage complexes, and chest radiograph revealed grossly enlarged cardiac silhouette. Transthoracic echocardiogram (TTE) showed sub mitral aneurysm with dilatation of the LV in its posterior area adjacent to the mitral valve with an ostial communication between the aneurysm and this cardiac chamber and severe mitral regurgitation. caronaru angiogram was done which revealed Single vessel disease of LCX - OM. After detailed evaluation she underwent submitral aneurysm repair+ mitral valve replacement with bio-prosthesis+ CABG with one graft to OM. Surgery was done under standard cardiopulmonary bypass support using a superior trans-septal approach. Left ventricle showed large blind pouch under the posterior mitral leaflet and non coapting mitral leaflets. The defect has thick fibrous edges and it was repired using PTFE patch with intermittent pledgetted prolene sutures. Mitral valve was replaced using 25 mm bioprosthesis with intermittent pledgetted polyester sutures.Saphenous vein graft was used to perform CABG to OM . Patient had remarkably outstanding recovery for her age and was extubated on same day evening , with total icu stay of 2 days and total hospital stay of 6 days. She is in routine follow up with us.
Submitral aneurysms can be asymptomatic or lead to a range of symptoms including:
- Mitral regurgitation (backflow of blood through the mitral valve).
- Left ventricular dysfunction.
- Heart failure.
- Thromboembolism (blood clots traveling to other parts of the body).
- Ventricular arrhythmias.
In some cases, ischemia due to compression of the coronary arteries.
Diagnosis
Echocardiography: A key diagnostic tool for visualizing the aneurysm and assessing its size and relationship to the mitral valve.
Conclusion
In conclusion, in such rare cases, a successful outcome depends on proper diagnosis, careful handling of the heart, planning of the approach to the aneurysm, and avoiding injury to the coronary vessel.
We at Aster RV hospital are operating such complicated procedures with excellent results
