Implantation of the HeartMate III Left Ventricular Assist Device in a Giant Left Ventricular Aneurysm

Left ventricular (LV) assist device implantation is considered to be a therapeutic option only in highly selected cases of giant LV aneurysm because of concerns regarding tissue consistence, potential mobilization of intracardiac thrombotic material, and thrombogenic properties of aneurysmal tissue.1 To facilitate secure placement of the inflow cannula, avoid embolic events, and attain LV remodeling, implantation of the device is performed in combination with LV reconstruction. A 51-year-old, white male patient was admitted for evaluation of an end-stage heart failure because of ischemic cardiomyopathy. Echocardiographic examination revealed severe systolic dysfunction (LV ejection fraction of 10%), significant thrombus in the giant LV aneurysm, and a contained apical wall rupture resulting from acute myocardial infarction (Figure). Despite interventional revascularization of the left anterior descending artery with a drug-eluting stent and medical therapy, including inotropic …