Echocardiographic Features of Large Posterobasal Left Ventricular Aneurysms

We describe the echocardiographic characteristics of 12 patients with left ventricular aneurysms involving posterobasal segments of the ventricular septum and of the adjacent ventricular wall. In 5, the septal as well as ventricular wall components of the aneurysm were both conspicuous; in 3 the septal but not ventricular wall component was large; and in 4 the ventricular wall part of the aneurysm was predominant. In all, the mouth (rim) of the aneurysm was wider than its fundus, thus distinguishing the posterobasal ventricular aneurysm from a pseudoaneurysm. The echographic features are striking, but are easily overlooked in standard echo planes. Aneurysmal complications (acquired ventricular septal defect, mural thrombus) can also be detected. Together with echo appearances, other consistent findings of this entity include deep, wide inferior Q waves, posteromedial papillary muscle calcification, and total or subtotal occlusion of right coronary or circumflex coronary artery.