A Giant Submitral Left Ventricular Aneurysm in a 40-Year-Old Man: A Rare Cause of Exertional Dyspnea and Mitral Regurgitation

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Submitral left ventricular aneurysm with severe mitral regurgitation and contained rupture (n=1). Intervention: Surgical aneurysm excision, direct suture neck closure, and mechanical mitral valve replacement (27 mm TTK Chitra). Primary outcome: Post-operative recovery and prosthetic mitral valve function.

Q: What does this research mean for the field?

Surgical excision combined with mitral valve replacement successfully manages giant submitral left ventricular aneurysms presenting with contained rupture and secondary mitral regurgitation in adults. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ajay Umakant Mahajan; Dhiraj Kumar; Dipesh Soni; Mohit Goyal

doi:10.7759/cureus.119141

November 4, 2026CureusOpen Access

A Giant Submitral Left Ventricular Aneurysm in a 40-Year-Old Man: A Rare Cause of Exertional Dyspnea and Mitral Regurgitation

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Why the study?

Submitral left ventricular aneurysm is a rare outpouching below the posterior mitral annulus that carries risks of rupture, progressive mitral regurgitation, arrhythmia, and embolism.

Key Points

To report the clinical presentation, echocardiographic features, and management of a rare giant submitral left ventricular aneurysm in a 40-year-old man.
Clinical and diagnostic evaluation of a 40-year-old man presenting with two weeks of exertional breathlessness and one week of dull chest discomfort.
Cardiovascular assessment utilizing transthoracic echocardiography and color Doppler to assess structural anatomy and intracardiac blood flow.
Transthoracic echocardiography demonstrated a giant submitral aneurysm measuring 8.7 × 4.6 cm with a 1.3 cm neck.
Examination revealed moderate mitral regurgitation, moderate pericardial effusion, preserved left ventricular systolic function, and color Doppler flow crossing the neck into the aneurysmal sac.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 40-year-old man from India with a giant submitral left ventricular aneurysm (8.7 x 4.6 cm), severe mitral regurgitation, and a contained pericardial hemorrhage, followed through post-operative day 7.

I

Intervention

Preoperative medical stabilization with furosemide 40 mg twice daily and enoxaparin 40 mg subcutaneously once daily for 2 days, followed by surgical aneurysm excision, direct suture closure of the single neck, and mitral valve replacement with a 27 mm TTK Chitra tilting-disc mechanical prosthesis via median sternotomy on cardiopulmonary bypass, and postoperative oral warfarin (target INR 2.5-3.5).

O

Outcome

Postoperative clinical recovery and prosthetic mitral valve function on echocardiography at discharge (postoperative day 7).

This case report highlights that a giant submitral left ventricular aneurysm can present in middle adulthood with a pericardial effusion representing contained rupture, necessitating caution with anticoagulation and urgent surgical excision with mitral valve replacement if the annulus is friable.

Limitations

Anti-streptolysin O titer, tuberculosis-specific testing, and pericardial fluid analysis were not performed, so rheumatic or tuberculous etiology cannot be excluded
Transesophageal echocardiography (TEE), CT, and cardiac MRI were not performed before surgery
Histopathology report is awaited, so the presence of myocardium in the sac wall has not yet been confirmed
Cardiopulmonary bypass and aortic cross-clamp times could not be retrieved from the records
Follow-up is limited to the early post-operative period
Anti-streptolysin O titer, tuberculosis-specific testing, and pericardial fluid analysis were not performed, so a rheumatic or tuberculous etiology cannot be excluded.
Transesophageal echocardiography (TEE), CT, and cardiac MRI were not performed before surgery.
The histopathology report is awaited, so the presence of myocardium in the sac wall has not yet been confirmed.
Cardiopulmonary bypass and cross-clamp times could not be retrieved from the records.
Follow-up is limited to the early post-operative period.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Supports surgical referral for symptomatic giant submitral LV aneurysms; leaves open optimal strategies pending larger studies.

Abstract

Submitral (annular subvalvular) left ventricular aneurysm is a rare outpouching of the left ventricular wall arising just below the posterior mitral annulus.It is most often described in young adults of African and Asian descent.We report a 40-year-old man with no prior comorbidities who presented with two weeks of exertional breathlessness and one week of dull chest discomfort.Transthoracic echocardiography showed a giant submitral aneurysm measuring 8.7 × 4.6 cm with a 1.3 cm neck, moderate mitral regurgitation, moderate pericardial effusion, and preserved left ventricular systolic function.Color Doppler showed flow from the left ventricle into the aneurysmal sac across the neck.There was no history or evidence suggestive of infective endocarditis or ischemic heart disease.The patient is hemodynamically stable and awaiting surgical repair while the etiological work-up continues.This case highlights the role of echocardiography in recognizing this uncommon entity and the importance of early surgical referral given the risk of rupture, progressive mitral regurgitation, arrhythmia, and embolism.

Discussion

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Cite This Study

Mahajan et al. (2026) conducted a case report in Submitral left ventricular aneurysm with severe mitral regurgitation and contained rupture (n=1). Surgical aneurysm excision, direct suture neck closure, and mechanical mitral valve replacement (27 mm TTK Chitra) was evaluated on Post-operative recovery and prosthetic mitral valve function.

synapsesocial.com/papers/6aee6bd871a7594806220c14 https://doi.org/10.7759/cureus.119141

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A Giant Submitral Left Ventricular Aneurysm in a 40-Year-Old Man: A Rare Cause of Exertional Dyspnea and Mitral Regurgitation

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

A Giant Submitral Left Ventricular Aneurysm in a 40-Year-Old Man: A Rare Cause of Exertional Dyspnea and Mitral Regurgitation

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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