Huge Left Ventricular Aneurysm in a Minimally Symptomatic 11-Year-Old Boy Stéphane Moniotte, MD, PhD,* Catherine Barrea, MD,* ‡ Cécilia Gonzalez, MD,* Thierry Sluysmans, MD, PhD,* ‡ Gébrine El Khoury, MD, † and Jean Rubay, MD, PhD †‡ Departments of *Pediatric Cardiology and † Cardiac Surgery, Cliniques Universitaires Saint-Luc, and ‡ Chaine de I’Espoir Belgique—Keten van Hope Belgïe, Brussels, Belgium ABSTRACT An 11-year-old boy presented with mild shortness of breath and tachycardia and was diagnosed with a huge left ventricular aneurysm ruptured in a secondary pseudoaneurysm. This report highlights the complementary use of echocardiography and cardiac magnetic resonance imaging in the preoperative assessment of this anomaly. Key Words. Aneurysm; Cardiovascular Diseases; Magnetic Resonance Imaging Case Report A n 11-year-old boy presented in Kinshasa (Democratic Republic of Congo) with mild shortness of breath and tachycardia. The patient was referred to our institution by a charity orga- nization (Chaîne de l’Espoir Belgique). Examina- tion revealed a hyperdynamic precordial bulge but no audible murmur, and no hepatomegaly. A decreased vesicular murmur was noted in the left lower pulmonary lobe. Heart rate was 71 bpm and saturation was measured at 98%. There was no previous history of chest trauma. Two-dimensional transthoracic echocardio- graphy demonstrated a giant aneurysm (10 cm ¥ 5 cm ¥ 12 cm), extending from the left ventricu- lar (LV) submitral region to the undersurface of the heart. Color Doppler examination showed low-velocity to-and-fro flow through the neck of the aneurysm (Figure 1 and Movies S1 and S2). The LV was dilated (5.9 cm, +5.1 Z-score), with borderline function (ejection fraction [EF] 59%). Magnetic resonance imaging demonstrated a bilobated aneurysm, with a submitral neck com- municating with the LV (Figure 2). Following surgical excision (Figure 3), pathology revealed a true aneurysm with dense connective tissue and absence of myocardial fibers. Follow up at 1 month revealed a persistent LV lateral wall dys- kinesis but a normal EF at 60%. Discussion Congenital LV aneurysm is a rare entity that appears to result from a developmental anomaly of the LV myocardium and endocardium, often involving the papillary muscles of the mitral valve. 1 The prognosis of the aneurysm is related to its size, location, degree of mitral valve involvement, and the presence of serious ventricular arrhyth- mias. Although clear indications for surgical treat- ment have not been published, surgery is generally recommended when the patient is symptomatic or when the aneurysm is associated with other cardiac anomalies. 2 In our patient, the pathogenesis of the disease was attributed to a congenital aneurysm that rup- tured in a secondary chamber (or pseudoaneu- rysm), as suggested by the bilobated magnetic resonance imaging appearance of the lesion, as well as by the absence of chest trauma in the patient’s history. The absence of myocardial fibers ruled out a ventricular diverticulum. In our experience, cardiac magnetic resonance imaging is well suited for the preoperative mor- phologic and functional evaluation of congenital LV aneurysms. 3 This three-dimensional technique offers several potential advantages, including clear depiction of myocardial morphology and wall motion, as well as assessment of myocardial perfu- sion and scar tissue. 46 © 2009 Copyright the Authors Journal Compilation © 2009 Wiley Periodicals, Inc. Congenit Heart Dis. 2009;4:46–49