**7. Clinical case**

Patient T, 56 year old was admitted to the department of cardiovascular surgery at Tomsk Institute of Cardiology in 4 months after transmural anterior-septal myocardial infarction with complaints on occasional angina pangs and dyspnea. The patient was examined rou‐ tinely. Holter monitoring showed ventricular extrasystoly (grade III by Lown). By EchoCG ejection fraction was 25% lower than normal (in B mode), LV was dilated with LV EDVI as high as 154 ml/m2 and LV ESVI of 116 ml/m2; local LV contractility was disturbed, there was found akinesis of apical, medial septal and anterior segments as well as hypokinesis of lateral and posterior-lateral segments. EchoCG also showed the 2nd type aneurysm.

By MRI there were found postinfarction cicatricial changes in all apical and, ventricular sep‐ tal and anterior segments; perimeter of the affected LV endocardium was 43%. In the apical and septal segments TI varied from 0,35 to 0,56. Data of coronaroventriculography showed LV deformation due to the aneurysm on the plane of anterior-lateral and apical segments and due to atherosclerosis of coronary arteries which included occlusion of the LAD artery in its proximal third and 75% stenosis of the right coronary artery. After mapping and elec‐ troanatomical LV reconstruction (Figure 3) there were identified the areas of an "electrical scar" on the apex, ventricular septum and anterior LV wall, zones of delayed conduction (pink dots in the picture) and those of double potential (blue dots) in transient zone, around the scar on ventricular septum and partially on the lateral LV wall. On the border of affected areas and viable myocardium radiofrequent (RF) dotty tags were applied (maroon dots in the picture) by an ablation lead.

After careful examination the decision was made to perform surgical myocardial revascula‐ rization and LV endoventriculoplasty with endocardectomy of the affected area. During the surgery we performed epicardial EPhS with overdriving stimulation of 200 impulses a mi‐ nute; VT was induced. In conditions of CP bypass and cardioplegia mammary-coronary ar‐ tery bypass grafting of the LAD artery, LV aneurysm dissection, endocardectomy of the apex, ventricular septum, anterior and lateral LV walls along RF tags were performed as well as SVR including endoventricular circular repair with a synthetic patch by the method of V.Dor. Postoperatively the patient received routine care. Postoperative period was un‐ eventful. By EChoG done in 3 weeks after the surgery one could notice better contractile car‐ diac function – LV EF grew up to 40% (B-made), LV sizes became smaller – EDVI was 70ml, ESVI – 48ml. The data of 24-hour ECG monitoring did not reveal any signs of ventricular rhythm disturbances. Postoperative mapping (Figure 5) showed significantly smaller transi‐ ent zone, lack of re-entry and VT.

**Figure 5.** Patient T, 56 year old. EPhS with LV reconstruction of the patient after LV aneurysmectomy (LVR) : electrical scar in the area of the patch. Low-potential areas with the potential from 0,5 mV and transient zones (from 0,5 to1,5 mV) take a limited area with no possibility of re-entry and VT induction. Front view, right oblique view. (original data)

The patient was discharged from the hospital in satisfactory condition.
