Ulcerated calcification of the interventricular septum causing Transient Ischemic Attacks: Case Report

BACKGROUND: Calcific deposits are frequently observed at sites of healed myocardial infarcts. Grossly visible calcification of myocardial infarcts and calcified intracavitary cardiac thrombi are less common but recently are becoming more frequent findings during surgical ventricular restoration procedures. CASE PRESENTATION: A 64 years old male diabetic patient experienced two episodes of transient ischemic attacks during the last six months. During the diagnostic work up he was found to have triple vessel coronary artery disease with mild left ventricular dysfunction, akinesia of the anterior-apical wall and hypokinesia of the inferior wall. He was referred to our department for coronary artery bypass grafting. He underwent elective triple coronary artery bypass and a ventricular restoration procedure due to apical wall thinning. The inspection of the left ventricle revealed an ulcerated round shape calcification of the interventricular septum with a crater filled with clot. We resected the above lesion and covered the damaged area with the septal Dacron patch of the modified linear closure. The patient was discharged from the hospital on the 11(th )postoperative day and has been doing well 6 months later, with improvement in both ventricular function and clinical status. CONCLUSION: The exploration of the left ventricular cavity reveals interesting phases of the post-infarction healing process. The suspicion of left ventricular thrombosis in patients with ventricular asynergy justifies a ventricular exploration during coronary artery bypass surgery.