Key result
Multimodal imaging identifies a giant calcified LV aneurysm managed medically after amiodarone terminates VT.
Why the study?
Giant post-infarction left ventricular aneurysms associated with extensive calcification and massive mural thrombus are rare and pose significant diagnostic and therapeutic challenges.
Case Report (n=1)
Highlights the complementary role of echocardiography and CT angiography in characterising giant thrombosed, calcified LV aneurysms and the need for individualised Heart Team management when surgical risk is prohibitive.
Answers are grounded in this paper and cite their sources.
Supports individualized medical management with anticoagulation and ICD consideration in prohibitive-risk giant LV aneurysms; leaves open prospective imaging and device trials.
Giant post-infarction left ventricular aneurysms associated with extensive calcification and massive mural thrombus are rare and pose significant diagnostic and therapeutic challenges. We report the case of a 72-year-old patient with ischaemic cardiomyopathy and severe left ventricular systolic dysfunction who presented with advanced heart failure symptoms and sustained ventricular tachycardia, successfully terminated with amiodarone. Transthoracic echocardiography and computed tomography angiography revealed a giant, calcified left ventricular aneurysm measuring 92 × 65 × 120 mm and containing a massive organised mural thrombus, associated with severe biventricular dysfunction and a left ventricular ejection fraction of approximately 20%. Following multidisciplinary Heart Team assessment, surgical intervention was considered excessively high risk. Management focused on optimised heart failure therapy and anticoagulation for the left ventricular thrombus, while an implantable cardioverter-defibrillator was considered for secondary prevention of sudden cardiac death. This case highlights the complementary role of echocardiography and computed tomography angiography in characterising aneurysm morphology, calcification, and intracavitary thrombus. It also underscores the complexity of balancing thromboembolic and arrhythmic risks against operative risk in patients with advanced ischaemic heart disease. A multidisciplinary approach and individualised therapeutic strategy are essential when surgical treatment is not feasible.
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Oudadda et al. (2026) conducted a case report in Giant calcified left ventricular aneurysm with massive mural thrombus, ischaemic cardiomyopathy, severe biventricular dysfunction, and sustained ventricular tachycardia (n=1). Amiodarone, optimised heart failure therapy, and anticoagulation was evaluated on Termination of sustained ventricular tachycardia and clinical management of giant thrombosed LV aneurysm. Transthoracic echocardiography and CT angiography identified a 92 × 65 × 120 mm calcified LV aneurysm with mural thrombus, managed medically after amiodarone terminated VT.
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