Results of surgical therapy in patients with left ventricular aneurysm

The clinical, angiographic and haemodynamic findings in 87 patients with left ventricular aneurysm were investigated before and after different surgical interventions. Thirty-four patients underwent aneurysmec-tomy alone (group I), 35 patients had additional coronary revascularization (group II), and 18 patients had revascularization alone because of the findings during operation (group III). The size of aneurysm was not significantly different in the three groups. Postoperatively, it decreased only in groups I and II. The majority of the patients in group I (predominantly one-vessel disease) had no angina pectoris, with no significant change early and late (more than 12 months) after operation. The patients in groups II and III (with more two- and three-vessel diseases) showed an improvement in angina pectoris. Preoper-atively, most patients had experienced exertional dyspnoea. Overall, there was no significant change after operation, but most patients showed an improvement in angina and dyspnoea when these symptoms had been the major indication for surgical therapy. Heart rate, systolic and end-diastolic pressures in the three groups did not change significantly after surgery. End-diastolic and end-systolic volumes decreased and ejection fraction increased significantly in groups I and II. In group III these variables did not change. Circumferential fibre shortening velocity in the residual ventricle increased significantly only in group I. Haemodynamic studies during exercise were performed in a total of 32 patients. In group I the increase of mean pulmonary pressure was significantly lower postoperatively; there was no significant change in groups II and III. At rest and during exercise only patients with aneurysmectomy showed an improvement in global and residual left ventricular function. Patients with angiographically proven aneurysm but viable myocardium -found during operation - showed no improvement in left ventricular function at rest or during exercise, if revascularization alone was performed. The hospital mortality was 6%. Three patients died during the follow-up period of cardiac causes. The high mortality of non-operated patients with clinical and haemodynamic findings similar to these surgically treated patients, warrants aneurysmectomy quite apart from the symptomatic and functional improvements after surgery