Subvalvular left ventricular
aneurysm is a
rare disease of obscure origin suggesting unique causes such as congenital, traumatic, and inflammatory or
infectious diseases. Its mortality is closely related to
heart failure,
mitral insufficiency, thromboembolic phenomena, and
cardiac arrhythmias. Although association with
coronary artery disease is not described, the compression of epicardial vessels by the
aneurysm may lead to ischemic manifestations. We report here a case of mitral subvalvular left ventricular
aneurysm of probable chagasic origin, in a patient with normal left ventricular function evolving with repeated episodes of monomorphic
ventricular tachycardia, despite noninducible electrophysiological testing and the use of optimal medical treatment, including
amiodarone. The indication for
implantable cardioverter-defibrillator in patients with
Chagas cardiomyopathy and segmental wall motion abnormalities but without global systolic dysfunction remains unclear in literature, even in the presence of complex ventricular arrhythmias. A brief review of the literature on morphological features, diagnosis, prognosis, and treatment will be also discussed.