Prospective study of surgery for left ventricular aneurysm

Abstract

To assess the effects of surgery for ventricular aneurysm on left ventricular performance 18 consecutive patients referred for such surgery were Studied prospectively. The patients had the following preoperative findings: ejection fraction by Isotope ventriculogram 28± 4 percent (mean ± standard error), New York Heart Association functional class 3.6 ± 0.1 and left ventricular noncontractile area 28 ± 3 percent by the graphic integration method. Thirteen patients had both angina pectoris and congestive heart failure, two had angina alone and three had congestive heart failure alone. All patients were studied before and after operation with isotope ventriculograms at rest and during exercise and treadmill exercise tolerance tests if their clinical status permitted these studies. Five patients also had postoperative cardiac catheterization. Catheterization data were in close agreement with the results of imaging studies. In 11 patients the aneurysm was resected and in 4 H was plicated; in 3, no discrete aneurysm was found. Sixteen patients including the three with no discrete aneurysm had concomitant coronary bypass grafting. There was no operative death and one late death. After operation, all patients had significant improvement in functional class (postoperative class 2.3 ± 0.1, p < 0.005). The amount of tissue resected (percent of total left ventricular surface area) was about 50 percent of the noncontractile area visualized on contrast angiography and there was a poor correlation between these two values (r = 0.56). Only four patients (22 percent) had either an increase in ejection fraction (range 8 to 13 percent) or a greater than 10 percent reduction in end-diastolic volume. Postoperative left ventricular end-diastolic pressure was unchanged. Thus, surgery for ventricular aneurysm can be accomplished with relatively small risk. Although functional Improvement is very common, it is not related to substantial improvement in global left ventricular function.