Ruptured Myocardial Aneurism

Clinical History

This specimen was obtained at post-mortem examination of a 54 year old woman who died suddenly eight weeks after admission to hospital for a myocardial infarct.

Pathology

This specimen is a heart which has been mounted to display the external surface, viewed from the anterior aspect. The left and right atria have been opened to display the atrial cavities and mitral and tricuspid valves. The heart is otherwise intact. In the antero-apical region of the left ventricle there is a large saccular aneurism 5x7x6 cm. in diameter. A small perforation 3 mm in diameter is present in the wall of the aneurism at its right lateral border. A fine rubber tube has been passed through the defect, which is surrounded by patchy haemorrhage. The parietal pericardium is firmly adherent to the lower half of the aneurism. The pericardial sac contains adherent thrombus, which is visible at the left lateral border of the aneurism. Fine fibrous adhesions are present on the epicardial surface over the antero-lateral aspect of the heart. The coronary arteries have been opened longitudinally. The anterior descending branch of the left coronary artery was occluded by thrombus (not visible in the specimen). This is an example of a ruptured myocardial aneurism following extensive antero-apical myocardial infarction.