Echocardiographical demonstration of a progressively expanding left ventricular aneurysm preceded by endomyocardial tearing

A 70-year-old woman with acute myocardial infarction (AMI) had a narrow nec ked left ventricular (LV) aneurysm and pericardial effusion. Although there had been no obvious sign of pseudoaneurysm at the first operation on the 1 3th day after onset, LV volume increased so dramatically that dyspnea on mi ld exertion was induced only 2 months after the onset of AMI. She underwent Dor's operation for the expanded LV aneurysm. The histological findings of the resected tissue, which were fibrotic epicardial lesion with small myoc yte islands, indicated a true aneurysm. The ultrasound manifestation of a n arrow necked aneurysm with abrupt thinning of the myocardium at the hinge p oint may be a valuable predictor of free wall rupture in the early phase an d severely progressive LV remodeling in the late phase. Such aneurysms need to be considered as high risk.