DOI: https://doi.org/10.36347/sasjs.2026.v12i08.014

Pages: 719-724

Left ventricular aneurysm (LVA) is a serious late mechanical complication of myocardial infarction and may be associated with ischemic mitral regurgitation (IMR), leading to or worsening severe left ventricular systolic dysfunction. We report the case of a 64-year-old man with diabetes and active smoking who was admitted with New York Heart Association (NYHA) class IV dyspnea. Transthoracic echocardiography and cardiac magnetic resonance imaging revealed a post-myocardial infarction left ventricular aneurysm, severe systolic dysfunction with a left ventricular ejection fraction of 30%, and severe ischemic mitral regurgitation. Coronary angiography demonstrated three-vessel coronary artery disease with chronic total occlusion of the right coronary artery. The patient underwent complete myocardial revascularization combined with surgical left ventricular reconstruction without mitral valve intervention. The postoperative course was uneventful, with clinical improvement and regression of mitral regurgitation to grade I. This case highlights the potential role of surgical ventricular reconstruction combined with coronary artery bypass grafting in restoring left ventricular geometry and hemodynamics, with secondary improvement of functional ischemic mitral regurgitation.