IDIOPATHIC SUBVALVULAR LEFT-VENTRICULAR A NEURYSMS - ANATOMICAL AND CLINICAL-FEATURES AND CLINICAL COURSE BASED ON A SERIES OF 13 CASES

The authors report 13 cases of idiopathic subvalvular left Ventricular aneurysm (ISVLVA), observed over a 7-year period in a total of 29,617 patients (0.04%). They describe the clinical features, results of com plementary investigations and clinical course of this disease. The dia gnosis was based on angiographic and anatomical findings in 4 cases an d on echocardiographic findings in 10 cases. This series consisted of 10 females and 3 males with a mean age of 37.3+/-2.1 years (range: 9 t o 72 years). Clinical signs consisted of palpitations in 2 cases, angi na pectoris in 4 cases, heart failure in 9 cases, and systolic murmur of mitral incompetence in 13 cases. Chest x-rays showed vaulting of th e left ventricle in 8 cases. (61.5%). ECG showed sinus rhythm in 11 ca ses, atrial fibrillation in 2 cases, ventricular tachycardia in 1 case and junctional tachycardia in 1 case. The erythrocyte sedimentation r ate was raised in 10 cases (76.9%). Complementary examinations reveale d ISVLVA, which was often very large, calcified (7 cases), thrombosed (6 cases), situated on the posterolateral surface of the left ventricl e, in a mitral subvalvular position (13 cases) and res ponsible for mi tral incompetence (13 cases). The coronary arteries were normal in the 5 cases in which they were studied. No aetiology was found. Complicat ions included death (1 case), heart failure (9 cases) and arrhythmias (3 cases). No systemic embolism was observed. Medical treatment (digox in, furosemide, antiarrhythmics) was considered to be fairly effective , but insufficient to prevent episodes of heart failure and arrhythmia s. Diagnosed ISVLVA must be operated: suture-resection of the neck of the aneurysm (4 of our cases) usually preservation of the mitral valve or, more rarely, valvuloplasty.