Subepicardial aneurysm with free wall rupture and its successful surgical intervention: a case report

Figure 1. Electrocardiogram on admission showing an abnormal Q wave and an inverted T wave in lead aVL, with a flattened T wave in a lead I.

Figure 2. (A) Cardiac computed tomography showing mild pericardial effusion (*), and an aneurysmal cavity at the inferolateral wall of left ventricle (LV) with a thin wall and a narrow neck (white arrow). (B) Three-dimensional reconstruction image showed that the aneurysm corresponded to the perfusion territory of first obtuse marginal branch (white arrow). LA, left atrium; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery.

Figure 3. Transthoracic echocardiography showing mild pericardial effusion (*), and an aneurysmal cavity located at the basal-inferolateral left ventricle (LV) (white arrows). (A) Long-axis view. (B) Short-axis view at the chordae level. (C) Apical four-chamber view. (D) Short-axis view at the papillary muscle level. (E) Apical three-chamber view. (F) Doppler colour flow imaging of apical three-chamber view showing blood flow within an aneurysmal cavity. AO, aorta; LA, left atrium; RV, right ventricle.

Figure 4. Coronary angiography of left coronary artery showing a narrowed first obtuse marginal branch with coronary slow flow (white arrows). LAD, left anterior descending artery; LCX, left circumflex artery.

Figure 5. Intraoperative images. (A) The aneurysmal cavity and pericardial space were separated by the layer of a thinning myocardium with a small line wound (white arrows). (B) After incising the wound from the outside, the connection between the aneurysm and the cardiac lumen through a narrow orifice was confirmed. (C) The left ventricle was sutured and fixed by surgical glue.