Ventricular aneurysm. An appraisal of diagnosis and surgical treatment.

Abstract

Twenty-three consecutive patients undergoing operation for left ventricular aneurysm are described with analysis of clinical and laboratory data obtained before and after operation. The reliability of various diagnostic methods is discussed. Five patients died in the perioperative period. Seven further patients have died during follow-up, 5 of recurrent myocardial infarction. The indications for operation are outlined with discussion of the benefits and limitations of current surgical treatment. It is felt that ventricular aneurysmectomy is indicated in a carefully selected group of patients. Though effects of surgical treatment on longevity cannot be completely evaluated, the status of the remaining coronary circulation appears to have an important influence on long-term survival.Though ventricular aneurysm was first described by John Hunter (I757), this condition has come to be clinically recognized as an important complication of myocardial infarction only in relatively recent times with the advent of improved methods of diagnosis. Modem cardiac surgical techniques have made curative treatment possible, and reports of large numbers of patients successfully treated by operation have appeared (Favaloro et al., i968; Cooley and Hallman, I968; Petrovsky, I966). Proper selection of patients for ventricular aneurysmectomy requires a detailed knowledge of the clinical course of patients with this condition and an understanding of the reliability of the various diagnostic methods applied to these patients. Surgical morbidity and mortality, and the results of long-term follow-up must be analysed. We have examined these features in 23 consecutive patients who underwent operations for ventricular aneurysm. Patients and methodsThe case records of 23 consecutive patients undergoing operation for ventricular aneurysm at the Hammersmith Hospital during the period I961-1970, inclusive, were reviewed. The clinical histories, course, findings on physical examination, electrocardiographic tracings, and other ancillary data were analysed in detail. Haemodynamic and angiographic findings at cardiac catheterization and selective coronary arteriography were reviewed. Findings at the time of operation were recorded. Details of postoperative follow-up on all 23 patients up to the time of writing were analysed. These observations and their relation to the available published material form the basis of this report. Unless otherwise indicated, Edwards' (I96I) definition of ventricular aneurysm as 'a protrusion of a localized portion of the external aspect of the left ventricle beyond the remainder of the cardiac surface, with simnultaneous protrusion of the cavity as well' will be applicable throughout this report. ResultsAge and sex Table i shows the age and sex distribution of the entire group of 23 patients. The ages listed are those at the time of operation. The mean age of all patients was 5i' years, with over half the patients in the age range 50-59. Only 2 patients were female, giving a male to female ratio of io 5: I.

Elective operations for left ventricular asynergy

“…Therefore, the surgical treatment of symptomatic left ventricle asynergy in patients where the area of resectable muscle is within a narrow range is a complicated matter. As stated in the introduction, we have accepted the functional definition of left ventricular aneurysm, and the consequent selection of candidates for operation makes our report not comparable with those of other authors (Cooley et al, 1958;Favaloro et al, 1968;Kay et al, 1970;Schattenberg et al, 1970;Loop, 1971;Graber et al, 1972;Stoney et al, 1973) who have used Edwards' (1961) definition of left ventricular aneurysm as 'a protrusion of a localized portion of the external aspect of the left ventricle beyond the remainder of the cardiac surface with simultaneous protrusion of the cavity as well'. This definition selects a population of patients with a clear anatomical lesion and may account for better surgical results.…”

“…Likoff and Bailey (1955) reported the use of clamps for a left ventricular aneurysmectomy by a closed heart technique, and Cooley, Collins, Morris, and Chapman (1958) reported the first open excision using cardiopulmonary bypass. Since then, a number of reports have been published on left ventricular aneurysmectomy with the use of cardiopulmonary bypass (Cooley and Hallman, 1968;Favaloro et al, 1968; Key, Aldridge, and 'Former Fellow in Cardiovascular Surgery, Department of Surgery, Stanford University School of Medicine, at Pacific Medical Center, San Francisco, California, 94115 MacGregor, 1968;Lindesmith et al, 1970;Kay et al, 1970;Schattenberg, Giuliani, Campion, and Danielson, 1970;Tice, Cheng, and Dolgin, 1970;Kluge et al, 1971;Loop, 1971;Graber et al, 1972; Stoney, Alford, Burrus, and Thomas, 1973). Between 1960 andDecember 1972 at the Pacific Medical Center in San Francisco, a total of 75 left ventricular aneurysmectomies were performed in patients with cineangiographic evidence of abnormal motion of the left ventricle, according to Gorlin's functional definition (Gorlin, Klein, and Sullivan, 1967), associated with clinical cardiac symptoms either chronic or acute.…”

Availability of111In-labeled platelet scintigraphy in patients with postinfarction left ventricular aneurysm

“…In follow-up studies, a marked decrease in platelet deposition within their aneurysms was observed in 5 patients (case 3,4,7,8,9) after treatment with an oral anticoagulant (300 mg/day of tichlopidine). A serial study was performed in one (case 3) of these five patients after the drug was stopped.…”

“…1,2 The complications of left ventricular aneurysm (LVA) are chronic congestive heart failure, ventricular tachyarrhythmia, arterial embolization and mural thrombus formation which are found during surgery or autopsy. [2][3][4][5][6] Systemic emboli occur in 6 to 13% of patients with LVA in clinical studies, [5][6][7] and the intraaneurysmal mural thrombi significantly increases the incidence of thromboembolic phenomena. 1 To identify the intraventricular thrombi, contrast ventriculography, two-dimensional echocardiography and contrast enhanced X-ray CT have been used successfully.…”

Identification of left ventricular thrombi in man using indium-111-labeled autologous platelets. A preliminary report.

“…"3 In recent years the primary role of coronary thrombus in precipitating AMI has been questioned. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] To evaluate the significance of coronary thrombus in AMI, we examined in detail the coronary arteries containing thrombi in 54 necropsy patients with transmural AMI. Several previously undescribed observations on coronary thrombi resulted, which clarify the significance of coronary thrombi in AMI.…”