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Shaikhrezai et al. Vessel Plus 2018;2:9 Vessel Plus
DOI: 10.20517/2574-1209.2018.17

Case Report Open Access

Repair of mitral subvalvular apparatus and a
calcified left ventricle aneurysm

Kasra Shaikhrezai , Sanjeet Singh Avtaar Singh , Karim Morcos , Steve Hunter 2
1
1
1
1 Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow G81 4DY, UK.
2 Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield S5 7AU, UK.
Correspondence to: Dr. Sanjeet Singh Avtaar Singh, Department of Cardiothoracic Surgery, Golden Jubilee National Hospital,
Glasgow G81 4DY, UK. E-mail: sanjeetsingh@nhs.net
How to cite this article: Shaikhrezai K, Singh SSA, Morcos K, Hunter S. Repair of mitral subvalvular apparatus and a calcified left
ventricle aneurysm. Vessel Plus 2018;2:9. http://dx.doi.org/10.20517/2574-1209.2018.17
Received: 29 Mar 2018 First Decision: 28 Apr 2018 Revised: 4 May 2018 Accepted: 7 May 2018 Published: 10 May 2018

Science Editor: Cristiano Spadaccio, Mario F. L. Gaudino Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
Left ventricle (LV) myocardial infarction may result in changes to the structure of the subvalvular apparatus. This may
lead to a functional regurgitation if accompanied by annular dilatation preventing coaptation of leaflets. Scar tissue
formation in the left ventricle may also lead to aneurysm of the left ventricle. This can then calcify, making repair of
the leaflet technically challenging. We present a case of a mitral valve repair with concomitant repair of left ventricle
aneurysm in a 75-year-old gentleman who suffered an ST-segment elevation myocardial infarction to the lateral wall
20 years ago. He presented with breathlessness on minimal activity, severe mitral regurgitation with a posteriorly
oriented regurgitant jet and calcification of LV aneurysm on chest X-ray and computed tomography scan. Despite the
challenging nature, it is possible to repair a mitral valve with concomitant calcified LV aneurysm formation. Long term
outcomes are still unknown for this cohort of patients.

Keywords: Transmural infarct, left ventricular dilatation, ischaemic mitral valve repair, left ventricular aneurysm with
calcification

INTRODUCTION
Left ventricle (LV) myocardial infarction (MI) may initiate a series of configurational remodelling of
[1]
the ventricle which leads to changes in the 3D geometry of the subvalvular apparatus . This chain of
events accompanied by annular dilatation may cause functional mitral regurgitation (MR). Another well-
recognised post MI complication is the LV aneurysm which may result in calcification of the aneurysm that
[2]
can be visualised on a chest radiograph . Generally LV aneurysm is considered as a deleterious outcome
© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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