Left Ventricular Aneurysm: A Late and Underrecognized Complication of Acute Myocardial Infarction — A Case Report

Abstract

Background:
Left ventricular aneurysm is an uncommon but clinically relevant late complication of acute myocardial infarction in the contemporary reperfusion era. It is associated with adverse ventricular remodeling, systolic dysfunction, functional mitral regurgitation, and increased risk of heart failure, arrhythmias, and thromboembolic events. Early recognition and appropriate risk stratification are
essential to guide management and avoid unnecessary invasive procedures.
Case presentation:
We report the case of a 71-year-old man with a history of ST-segment elevation myocardial infarction two years prior, managed conservatively without documented reperfusion. He presented with progressive exertional dyspnea and reduced exercise tolerance. Transthoracic and dobutamine stress echocardiography revealed a true chronic left ventricular aneurysm involving the mid anterolateral, mid inferolateral, and basal inferior segments, associated with reduced left ventricular ejection fraction and moderate functional mitral regurgitation, without evidence of contractile reserve or inducible ischemia. Given the absence of myocardial viability and high procedural risk, a conservative, optimized medical approach was adopted.
Conclusion:
This case highlights left ventricular aneurysm as a late and underrecognized complication of myocardial infarction. Advanced echocardiographic evaluation was crucial in confirming irreversible myocardial injury, guiding individualized management and preventing unnecessary invasive interventions