Ischaemic Cardiac Aneurysms and Ventricular Septal Defects:Surgical Treatment with and Without Revascularization

During the period 1968--78, 35 patients with left ventricular aneurysm after acute myocardial infarction were operated on at the Department of Thoracic and Cardiovascular Surgery, University Central Hospital, Helsinki. Twenty patients underwent resection of the left ventricular aneurysm and had coronary bypass grafting (Group I) and 15 patients had aneurysmectomy without revascularization procedures (Group II). Most of the patients (21) had the operation within one year after acute myocardial infarction. The aneurysm was located in the anterior wall in 31 cases and in the posterior wall in 4 cases. Three patients in Group II had a concomitant ventricular septal rupture, which was repaired simultaneously with the aneurysmal resection. In average, the patients in Group I had bypass grafting in 1.8 coronary branches. There were no intra-operative deaths. Three patients in the revascularization group died and 2 patients in the non-revascularization group died during hospitalization (15% hospital mortality). Two patients in the revascularization group and one in the non-revascularization group died during the average follow-up time of 3.4 and 6.4 years for the respective groups (late mortality 10 and 7%). The rest of the patients were doing well, including those with repaired VSDs. Follow-up coronary angiography was carried out of 12 patients; in 10 all the grafts were patent and in 2 one revascularized coronary branch had a patent graft. Revascularization produced apparent relief of anginal symptoms. Its beneficial effects on longevity remained unestablished.