A new classification of chronic postinfarction aneurysms of the left ventricle in patients with coronary artery disease

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Abstract

The article highlights the historical moments of how the concepts for the diagnosis and treatment of postinfarction aneurysms of the left ventricle were developed, and the possibilities of the main diagnostic methods. As a rule, patients with chronic postinfarction aneurysms of the left ventricle have severe damage to their coronary bed, requiring invasive correction (coronary artery stenting or coronary artery bypass grafting), which must be performed either before or during the intervention to eliminate the left ventricular aneurysm. A new classification of chronic postinfarction aneurysms of the left ventricle is proposed, which takes into account rather the type of myocardial blood supply and the severity of damage to the coronary bed, than the actual features of aneurysms. It determines the stages and tactics of treatment of patients with chronic postinfarction aneurysms of the left ventricle, focusing on the problem of coronary revascularization.

About the authors

Aleksandr V. Bocharov

Republican Clinical Hospital; Kostroma Regional Clinical Hospital named after Korolev E.I.

Author for correspondence.
Email: bocharovav@mail.ru
ORCID iD: 0000-0002-6027-2898
SPIN-code: 6073-1445

M.D., Ph.D., Dr. Sci. (Med.)

Russian Federation, 39, Barbashova str., Vladikavkaz, 362003; Kostroma

Leonid V. Popov

National Medical and Surgical Center named after N.I. Pirogov

Email: popovcardio@mail.ru
ORCID iD: 0000-0002-0530-3268

M.D., Ph.D., Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Astan K. Mittsiev

Kostroma Regional Clinical Hospital named after Korolev E.I.; North-Ossetian State Medical Academy

Email: 8-an@inbox.ru
ORCID iD: 0000-0002-5814-0060

M.D., Ph.D., Dr. Sci. (Med.), Professor

Russian Federation, Kostroma; Vladikavkaz

Magomet D. Lagkuev

Kostroma Regional Clinical Hospital named after Korolev E.I.

Email: magometlag@mail.ru
ORCID iD: 0000-0002-5773-6196
Russian Federation, Kostroma

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2. Fig. Table 1. Classification of postinfarction left ventricular aneurysms in patients with coronary artery disease

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3. Fig. 1. Coronary angiographic picture of lesions of the coronary bed and postinfarction aneurysm of the left ventricle according to type D1: a — coronary angiography of the left coronary artery (white arrows — the bed of the anterior descending artery occluded in the proximal third; red arrows — hemodynamically significant lesion of the envelope artery, extended echeloned stenoses up to 75% of the envelope artery); б — extended echeloned stenoses up to 85% of the proximal and middle parts of the right coronary artery, as well as its branches (indicated by green arrows); в — retrograde filling of the distal and middle third of the anterior descending artery from the basin of the right coronary artery, collateral blood flow Rentrop III (indicated by white arrows).

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4. Fig. 2. Coronary angiographic picture of the lesion of the coronary bed and postinfarction aneurysm of the left ventricle according to type D2: a — hemodynamically significant stenosis of the trunk of the left coronary artery 70%, echeloned stenosis of the anterior descending artery up to 70%, subocclusion of the mouth of the 1st diagonal branch (indicated by white arrows); occlusion of the proximal half of the envelope artery (indicated by red arrow); б — discrete subocclusion of the proximal third of the right coronary artery (indicated by the green arrow); в — the right coronary artery after performing the first stage of treatment — stenting of the proximal third (the stenting zone is indicated by an arrow).

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5. Fig. 3. Coronary angiographic picture of the lesion of the coronary bed and postinfarction aneurysm of the left ventricle type S1: а — hemodynamically significant stenoses of the proximal and distal parts of the anterior descending artery, the proximal part of the 1st diagonal artery (indicated by white arrows), the proximal half of the envelope artery and its branches (indicated by red arrows); б — the right coronary artery.

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6. Fig. 4. Coronary angiographic picture of the lesion of the coronary bed and postinfarction aneurysm of the left ventricle type S2: а — occlusion of the anterior descending artery in the proximal third (white arrow), stenosis of the 1st diagonal artery in the proximal segment 70% (blue arrow), subocclusion of the intermediate artery in the proximal segment (yellow arrows); б — hemodynamically significant stenoses at the border of the proximal and middle thirds ( 90%), as well as the middle and distal third (85%) of the right coronary artery (green arrows); в — the right coronary artery after stenting (stenting zones are indicated by green arrows).

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Copyright (c) 2021 Bocharov A.V., Popov L.V., Mittsiev A.K., Lagkuev M.D.

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