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A 42-year-old male presented with sustained ventricular tachycardia of left bundle branch block (LBBB) morphology with left axis deviation (figure 1A) that terminated with amiodarone infusion. He gave a history of episodic palpitations associated with giddiness. Transthoracic and transoesophageal echocardiography showed a wide necked submitral aneurysm measuring 5×5 cm with severe mitral regurgitation (figure 1B,C).
Coronary angiogram revealed a dominant right coronary artery with spontaneous dissection of mid and distal segments with splaying of the distal branches overlying the aneurysm (figure 2A,B). Ventricular tachycardia of right and left bundle branch block morphologies was induced with single ventricular extrastimuli during electrophysiological testing. MRI clearly demonstrated the aneurysm below the mitral valve (figure 2C,D). The patient was prescribed oral amiodarone and advised surgical resection of submitral aneurysm with mitral valve repair or replacement.1
Submitral aneurysm is rare outside African blacks and uncommonly presents with ventricular arrhythmias.2 While the aetiology is considered to be congenital, coronary abnormalities have occasionally been described in association with this condition, although the relationship of the coronary abnormality to the aneurysm is unclear in our patient.
Contributors PK contributed to management of the patient and preparation of the manuscript. JB oversaw the management of the patient. RJS was involved in management of the patient and preparation of the manuscript. JB and RJS accept full responsibility and will act as guarantors for the completed paper.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.