True left ventricular aneurysm and healed myocardial infarction: Clinical and necropsy observations including quantification of degrees of coronary arterial narrowing

Clinical and necropsy observations are described in 28 patients (24 men) aged 31 to 85 years (mean 62) with healed myocardial infarction and a true left ventricular aneurysm. In contrast to findings in other subsets of necropsy patients with fatal coronary heart disease, chronic congestive heart failure was frequent (22 patients); angina pectoris was infrequent (4 patients) and, when present, never severe; recurrence of acute myocardial infarction (2 patients), sudden death (2 patients) and clinically evident systemic emboli (1 patient) were infrequent; survival for more than 5 years after healing of the acute infarction was infrequent (in 3 of 21 patients with clinically diagnosed acute myocardial infarcts); and survival for longer than 1 year after aneurysmectomy was lacking (0 of 7 patients). Additionally, 23 of the 28 patients had a large heart (greater than 400 g [mean 523], 26 had dilated nonaneurysmal portions of the left ventricle, and all but 1 had a large (greater than 30 percent of the left ventricular wall) myocardial infarct. In 25 of the 28 patients, two or more of the four major epicardial coronary arteries were greater than 75 percent narrowed in cross-sectional area by atherosclerotic plaques. In 992 segments (each 5 mm long) of a major coronary artery examined in 22 patients (45 segments/patient), narrowing was greater than 75 percent in 323 segments (33 percent) and ranged from 51 to 75 percent in 419 (42 percent), from 26 to 50 percent in 210 (21 percent) and from 0 to 25 percent in 40 (4 percent). Thus, the scarred, hypertrophied and aneurysmally dilated left ventricle infrequently produces chest pain or fatal arrhythmia despite diffuse, severe coronary narrowing.