A giant left ventricular aneurysm in an apparently asymptomatic child. the value of multimodality assessment for risk stratification

Congenital left ventricular aneurysm (LVA) is a rare abnormality most commonly located at the LV apex. It must be differentiated from left ventricular diverticulum (LVD). Congenital LVA is typically isolated, whereas the latter is often associated with other congenital heart disease and midline thoraco-abdominal wall defects. A large apical LVA was diagnosed in a 3-year-old girl referred after incidental cardiomegaly was detected on chest radiography. At this center, LVA was confirmed by echocardiography, magnetic resonance imaging, and angiography. The patient subsequently underwent surgical aneurysmorrhaphy. Notably, during surgical resection, the aneurysm was found to be filled with massive thrombotic material, composed primarily of extensive thin fibrous tissue and appeared highly prone to rupture. This case highlights the potential discrepancy between clinical presentation and disease severity, especially in a 3 year who is unaware of important clinical symptoms in this regard. The pathological report confirmed the diagnosis. Left ventricular aneurysm appears as an akinetic or dyskinetic protrusion composed primarily of fibrous tissue and lacking organized myocardium. Although some patients can be managed medically, others require surgical intervention to prevent lethal complications.