Submitral left ventricular aneurysm

NORMAL CARDIAC ANATOMY

The anterior mitral leaflet is in fibrous continuity with the aortic valve and fibrous skeleton.

The posterior leaflet is attached to the pliant endocardium instead of rigid fibrous skeleton.

For this reason, annular dilatation, a cause of MR, has a greater effect on posterior leaflet function than on anterior leaflet function

Figure 1: Dark chambers in the image are RA and RV, Bright chambers are LA and LV, Black arrow is left ventricular outflow tract.

Figure shows continuity between anterior mitral leaflet ( white arrow ) and left ventricular outflow tract leading to aorta

SUBMITRAL LEFT VENTRICULAR ANEURYSM 

1. Congenital origin or predisposition

2. Junctional defect between cardiac muscle 
and fibrous structure of heart

3. Can extend behind LA, LV

4. Aneurysmal growth causes mitral apparatus distortion and can lead to MR and cardiac failure

5. Should be suspected with embolism and ventricular arrhythmias and absence of coronary artery disease

Figure 2: Red arrow represents connection of aneurysm with LV just adjacent to the posterior mitral leaflet.