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A 66 year old man was referred to our hospital with post-infarction angina. He had experienced an inferior myocardial infarction 21 and 15 years previously, and an anteroseptal myocardial infarction two years previously. He was scheduled for coronary angiography on day 3 after hospitalisation. Left ventriculography showed akinetic inferior and anterior walls, proximal occlusion of the right coronary artery (RCA), occlusion of the circumflex coronary artery (Cx), and occlusion of the distal third at the left anterior descending (LAD) coronary artery. Intense collateral circulation was observed. Due to the persistence of angina, coronary bypass surgery was indicated. During surgery, after opening the pericardium, an abnormality was found in the anterior wall of the right ventricle. Near the right ventricular outflow tract an aneurysm was observed (left upper panel). Four saphenous vein grafts were used for the RCA, LAD, Cx, and diagonal revascularisation. The right ventricular aneurysm was not corrected. At the end of the procedure there was no difficulty weaning the patient off cardiopulmonary bypass. There were no postoperative complications; the patient was discharged seven days after the operation and is doing well eight weeks postoperatively. Echocardiography (right upper panel) and magnetic resonance imaging (panels A and B) performed on day 15 postoperatively confirmed the right ventricular aneurysm. To our knowledge this patient is the third case to be described in the literature and the first directly visualised.
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