Results of surgical therapy in patients with left ventricular aneurysm

The clinical, angiographic and haemodynamic findings in 87 patientswith left ventricular aneurysm were investigated before andafter different surgical interventions. Thirty-four patientsunderwent aneurysmec-tomy alone (group I), 35 patients had additionalcoronary revascularization (group II), and 18 patients had revascularizationalone because of the findings during operation (group III).The size of aneurysm was not significantly different in thethree groups. Postoperatively, it decreased only in groups Iand II. The majority of the patients in group I (predominantlyone-vessel disease) had no angina pectoris, with no significantchange early and late (more than 12 months) after operation.The patients in groups II and III (with more two- and three-vesseldiseases) showed an improvement in angina pectoris. Preoper-atively,most patients had experienced exertional dyspnoea. Overall,there was no significant change after operation, but most patientsshowed an improvement in angina and dyspnoea when these symptomshad been the major indication for surgical therapy. Heart rate, systolic and end-diastolic pressures in the threegroups did not change significantly after surgery. End-diastolicand end-systolic volumes decreased and ejection fraction increasedsignificantly in groups I and II. In group III these variablesdid not change. Circumferential fibre shortening velocity inthe residual ventricle increased significantly only in groupI. Haemodynamic studies during exercise were performed in atotal of 32 patients. In group I the increase of mean pulmonarypressure was significantly lower postoperatively; there wasno significant change in groups II and III. At rest and during exercise only patients with aneurysmectomyshowed an improvement in global and residual left ventricularfunction. Patients with angiographically proven aneurysm butviable myocardium -found during operation - showed no improvementin left ventricular function at rest or during exercise, ifrevascularization alone was performed. The hospital mortality was 6%. Three patients died during thefollow-up period of cardiac causes. The high mortality of non-operatedpatients with clinical and haemodynamic findings similar tothese surgically treated patients, warrants aneurysmectomy quiteapart from the symptomatic and functional improvements aftersurgery