Surgical Ventricular Restoration With the Dor Procedure for Anterior Left Ventricular Aneurysm and Suspected Rupture: A Case Report

Surgical ventricular restoration (SVR) using the Dor procedure has become uncommon in the era of early myocardial revascularization and optimized medical therapy.However, in carefully selected patients with advanced left ventricular (LV) remodeling or suspected ventricular rupture, SVR remains a critical surgical option.We report the case of a 55-year-old who presented with chest pain and progressive dyspnea one month after an untreated myocardial infarction.Imaging revealed a large anterior LV aneurysm with features suggestive of a contained rupture.Despite revascularization of the left anterior descending (LAD) artery, the patient developed hypotension requiring inotropic support and underwent urgent SVR using the Dor procedure.Intraoperative findings confirmed extensive dyskinetic myocardium, a large laminated thrombus, and a sealed rupture of the apical wall.The thrombus was evacuated and the dyskinetic segment excluded using a tailored Dacron patch.The postoperative course was uneventful.At the latest follow-up, 22 months after surgery, the patient remained clinically stable, with a left ventricular ejection fraction above 30% and no arrhythmic events; however, apical dyskinesia with aneurysmal dilation had reappeared, indicating that remodeling may continue after SVR.This report highlights that the Dor procedure remains a valuable and potentially life-saving intervention in selected patients with post-infarction LV aneurysms complicated by suspected rupture, particularly when timely diagnosis and surgical intervention are achieved.