Early Outcomes of Repair of Left Ventricular Apical Aneurysms in Patients With Hypertrophic Cardiomyopathy.

Abstract

Apical aneurysms are outpouchings at the apex of the left ventricle, described as discrete, thin-walled dyskinetic or akinetic segments of the most distal portion of the ventricular chamber (Figure). Apical aneurysms are relatively rare in hypertrophic cardiomyopathy (HCM) with subaortic obstruction, but have been reported in 15% to 30% of patients with apical HCM (ApHCM) or midventricular obstruction (MVO). Aneurysms are associated with a wide spectrum of adverse outcomes including sudden cardiac death, ventricular arrhythmias, heart failure, and mortality.1,2 In a cohort of 93 patients with HCM and apical aneurysms, Rowin and colleagues1 reported a combined adverse event rate (cardiac-related mortality, heart failure, malignant arrhythmias requiring intervention, and thromboembolic events) of 6.4% per year. Furthermore, in a recent review, Jan et al2 reported overall mortality in patients with apical aneurysms of 9% to 10.5% over a mean/median follow-up of 2 to 6.5 years. Figure. Apical aneurysms in hypertrophic cardiomyopathy. A , Apical aneurysm of the left ventricle and midventricular obstruction. B , Dashed lines depict site of aneurysm resection and myectomy. C , Enlarged ventricular cavity, and resolution of midventricular obstruction and aneurysm following surgery. D , Preoperative transthoracic …