Heart transplantation for rapidly progressive dilated cardiomyopathy complicated by an inferolateral left ventricular aneurysm: a case report

Abstract

Left ventricular (LV) aneurysm most commonly follows transmural myocardial infarction and is rarely described in dilated cardiomyopathy (DCM). When DCM and ischemic injury coexist, the presentation may be atypical and progression can be rapid. A 52-year-old man developed chest tightness and dyspnea after an upper respiratory tract infection. Echocardiography showed LV dilatation with reduced systolic function (LVEF 36%). Coronary angiography on hospital day 4 demonstrated severe stenoses of the left circumflex/obtuse marginal branch and a moderate right coronary artery lesion, and a drug-eluting stent was implanted in the left circumflex artery. One month later, he was readmitted with recurrent dyspnea, BNP 2,627 ng/L, complete left bundle branch block, marked LV dilatation (end-diastolic diameter 113 mm), severe functional mitral regurgitation, and a large inferolateral apical LV aneurysm (74 mm × 50 mm) with paradoxical motion. Despite intensified heart failure therapy, he progressed to end-stage heart failure and underwent heart transplantation. Histopathology of tissue adjacent to the aneurysm was consistent with myocardial infarction with chronic inflammatory cell infiltration, and the sampled left circumflex artery showed atherosclerotic stenosis. In DCM with new regional wall motion abnormalities or rapid structural deterioration, concomitant ischemic injury should be considered even when symptoms are non-specific. Electrical and mechanical dyssynchrony may increase regional wall stress and contribute to aneurysm formation, accelerating clinical decline.