| Abstract [eng] |
Left ventricular aneurysm and thrombus are clinically significant complications of acute myocardial infarction. According to the literature, surgical treatment of aneurysm and thrombectomy is performed in cases of persistent angina pectoris, refractory heart failure, thromboembolism, and life-threatening tachyarrhythmias. Since infarcted tissues are fragile emergency surgery increases mortality due to the technical difficulties, hence, it is recommended to postpone surgical treatment until scar formation occurs. However, in cases of high risk of systemic embolism or very low left ventricle ejection fraction performing the surgery sooner may be considered. There is a lack of guidelines in the literature indicating the best treatment strategy and the optimal timing for surgery. Currently, the choice of treatment is based on the individual experience of treatment centers, descriptions of cases, and case series. A clinical case is retrospectively examined: a left ventricular aneurysm with a mobile, protruding thrombus was diagnosed in a patient 3 weeks after acute myocardial infarction. It was decided to treat the patient with medications and reassess his condition. Approximately 2.5 months after the diagnosis left ventricular restoration surgery, thrombectomy and coronary artery bypass grafting were performed. Based on the clinical case analysis and literature review, it is concluded that surgical treatment can be delayed for patients with aneurysm and thrombus in the left ventricle following acute myocardial infarction. Patients undergoing conservative treatment before surgery should be monitored and left ventricular function and thrombus should be evaluated repeatedly. |
