SUMMARY Fourteen consecutive patients undergoing left ventricular aneurysmectomy and coronary artery bypass grafting were studied by multiple gated ventricular scintigraphy at rest and during exercise before and at six weeks and six months after surgery. All had congestive heart failure and 12 angina pectoris. Before operation left ventricular ejection fraction fell significantly with exercise, as did the regional wall motion score. Six weeks after surgery all surviving patients were free of angina, with an improvement in functional class; the total exercise workload improved significantly, but resting left ventricular ejection fraction was unchanged; the regional wall motion score improved in both the anterior and left anterior oblique projections, although extensive areas of abnormal contraction persisted. Exercise left ventricular ejection fraction improved significantly after operation at six weeks, and previous exercise induced abnormalities of regional contraction were abolished. Six months after operation angina pectoris had recurred in one patient, but there was no further change in ventricular function in the remainder.Although resting ejection fraction is not improved, symptoms, exercise workload, and exercise ventricular function can be improved by aneurysmectomy and coronary artery bypass grafting, but the respective contribution of these two procedures remains uncertain.Left ventricular aneurysm is a well recognised and important complication of myocardial infarction. The incidence after infarction varies widely, owing to differing diagnostic criteria but is between 2% and 15%. after aneurysmectomy has been reported'°112 but not without an appreciable operative risk, the early mortality rate being 6-22%.6 12-14 Despite these reports of symptomatic benefit a need exists for more objective studies of left ventricular function before and after surgery. The purpose of our prospective study was to assess left ventricular function in a consecutive group of patients referred for elective surgery of their postinfarction aneurysm and to correlate these findings with the symptomatic state of the patient. All had multivessel coronary artery disease and underwent additional myocardial revascularisation. Patients were studied before and six weeks and six months after surgery by multiple gated ventricular scintigraphy both at rest and during dynamic supine exercise. This method provides a non-invasive, geometrically independent method of assessing serial left ventricular function. Patients and methods STUDY POPULATIONFourteen consecutive patients (13 men, one woman; mean age 51-7 (range 38-69) years) referred for elec-145 on 27 April 2019 by guest. Protected by copyright.

suMMARY The effect of coronary artery bypass grafting on global left ventricular ejection fraction and regional contraction was studied in 56 consecutive patients with chronic stable angina pectoris by means of multiple gated ventricular scintigraphy at rest and during dynamic supine exercise before and six weeks after myocardial revascularisation.Before operation, exercise induced a significant fall in ejection fraction and regional wall motion score. Six weeks after operation 52 patients were symptomless. Resting ejection fraction and regional wall motion score were unchanged but during exercise ejection fraction increased significantly, and the previous exercise induced regional wall motion abnormalities were abolished. All