Left Ventricular Aneurysmectomy Research Articles

Large Left Ventricular Pseudoaneurysm Presenting as an Embolic Stroke After a "Silent" Myocardial Infarction.

A 72-year-old woman with no history of coronary artery disease presented with an acute left middle cerebral artery stroke and was found to have a large left ventricular pseudoaneurysm measuring 8.7 × 7.6 cm and 2 large left ventricular thrombi, the source of her systemic embolization. Despite initial medical management, she developed refractory New York Heart Association functional class III heart failure, uncontrolled atrial fibrillation, and further enlargement of her pseudoaneurysm to 5.5 × 10.6 × 9.2 cm. She underwent urgent aneurysmectomy. Left ventricular pseudoaneurysms are rare and most commonly occur following an acute myocardial infarction when a ventricular free-wall rupture is contained by pericardium or thrombi. Historically, left ventricular angiography displaying a lack of an overlying coronary artery was the gold standard for diagnosis. Now, noninvasive imaging such as computed tomography, magnetic resonance imaging, and echocardiogram with ultrasound-enhancing agent, are reliable diagnostic tools. They can distinguish a pseudoaneurysm from a true left ventricular aneurysm using characteristic findings such as a narrow aneurysm neck, bidirectional doppler flow between the pseudoaneurysm and the left ventricle, and abrupt changes in the cardiac wall structures. Progressive dilation, wall thinning, and dyskinesis can result in refractory heart failure, arrhythmias, and thrombi formation from venous stasis. Pseudoaneurysms have a 30% to 45% risk of rupture and can be treated with left ventricular aneurysmectomy.

Organ-saving surgical alternatives to treatment of heart failure.

Over time, various surgical treatment strategies have evolved to manage advanced heart failure (HF). Scientific and technological breakthroughs through the last 50 years have put forward various surgical alternatives to patients with advanced HF encompassing surgical ventricular restoration to surgical gene therapy and stem cell replacement of the diseased ventricles. Organ-saving surgical options which used to be promising included dynamic cardiomyoplasty, partial resection of ventricle and cardiac wrapping with Acorn CorCap cardiac support device. These procedures were eventually abandoned due to negative outcomes and without proven disadvantages. Another organ-saving surgical option currently being considered but still make little sense is cardiac regeneration by stem cell therapy, i.e., cardiomyocyte restoration and replacement. Presently, the organ-saving surgical alternatives to treat end-stage HF are revascularization for ischemic cardiomyopathy, mitral valve surgery (repair or replacement) for ischemic mitral incompetence (IMI), left ventricular (LV) aneurysmectomy (surgical ventricular restoration) and mitral valve repair for IMI. These aforementioned procedures have become quite established approaches and with increasing experience are continuously being modified to improve outcome. Various mechanical circulatory support systems have emerged over time to improve functional status of patients with advanced HF, either as a bridge to heart transplantation or as a bridge to myocardial recovery. Likewise offered in those with contraindications to transplantation. Ventricular assist devices (VAD) can keep patients alive until an eventual transplantation. This article reviews the variety of the myriad of alternative organ-saving surgical alternatives that have been available or are currently available provided to patients with end-stage HF, their advantages and deficiencies, as well as prospects in HF therapy.

Analgesia with blockage of the erector plane of the spine in the postoperative period of cardiac surgery. Case report

ABSTRACT BACKGROUND AND OBJECTIVES: Persistence of pain in the postoperative thoracic region is very common with conventional analgesia performed only with opioids, which prolongs recovery, increasing costs and morbidity. Erector spinae plane blockage is a promising technique for the analgesic control in the postoperative period of cardiac surgeries. The purpose of this study was to describe a case in which erector spinae plane blockage provided adequate postoperative analgesic control. CASE REPORT: A 61-year-old male patient submitted to elective cardiac surgery for left ventricular aneurysmectomy and coronary artery bypass grafting. On the first postoperative day presented pain of intensity 8 on the visual analog scale in the left hemithorax. The patient underwent erector spinae plane blockage with a catheter located at T5 guided by ultrasound with a 17G Tuohy needle and injection of 20mL of 0.5% ropivacaine providing important decrease and improvement of pulmonary expansibility. CONCLUSION: Erector spinae plane blockage provided adequate analgesia and was considered a good therapeutic option.

Impella-Supported Cardiac Surgery

Background: Impella left ventricular assist devices are useful tools for the treatment of cardiogenic shock. The peri-operative use of Impella in patients with low left ventricular ejection fraction (LVEF) undergoing cardiac surgery, can be valuable for cardiac surgeons to prevent postcardiotomy cardiogenic shock. Methods: From September 2018 to June 2019, 10 patients underwent cardiac surgery supported by Impella 5.0. Five patients underwent off-pump coronary artery bypass (OPCAB), two had OPCAB and mitral valve repair (MVR), and one each had aortic valve repair (AVR) plus MVR, OPCAB plus AVR, and left ventricular aneurysmectomy plus MV replacement. The Impella 5.0 was inserted surgically one day before the operative procedure via a side conduit through the left femoral artery in 8 cases and right axillary artery in 2 cases. The mean age of patients was 63 ± 7 years. Mean LVEF at baseline was 27.5% (20-32%) and mean duration of Impella support was 7 days (4-12 days). Results: Hemodynamics improved immediately after the initiation of mechanical support. The cardiac surgical procedures were conducted in the usual manner. All patients received low dose of postoperative inotropes. Cardiac-related mortality was 10% (1/10), due to multiorgan failure (MOF) in 1 patient who underwent OPCAB. Major intracranial bleeding occurred in 2 patients who received extracorporeal circulation (ECC). Impella support was weaned in all patients after hemodynamics was optimized without inotropes, except the patient with MOF. The survivors had no major complications and were discharged to medical therapy at mean of 21 days. Conclusion: Impella support is feasible for preconditioning before surgery and in the postoperative period. It enables cardiac surgery in patients with low EF using a low dose of inotropes and helps to prevent postcardiotomy cardiogenic shock. Impella support during OPCAB allows for easier positioning and unloading the heart. The underlying cause for intracranial bleeding in two cases despite successful weaning from Impella support remains to be understood.

P1273 Effects of surgical septal myectomy on left ventricular function in patients with hypertrophic obstructive cardiomyopathy

Abstract Introduction and Purpose Surgical left ventricular (LV) septal myectomy in patients with obstructive hypertrophic cardiomyopathyhas been shown to reduce left ventricular outflow tract (LVOT) gradient and improve symptoms. We investigated changes in strain analysis, LA volume and LV systolic and diastolic function in patients with HOCM after surgical septal myectomy. Methods We enrolled consecutive 30 patients (age 63.7 ± 11.0 years, 47% Female), who underwent surgical LV septal myectomy for HOCM from 2012 to 2019. We evaluated LV dimension, LVOTG, LV-stroke volume, LV in flow pattern (E wave, A wave, Dct), e’(septal and lateral), LA volume, mitral regurgitation (MR), systolic anterior motion of mitral valve (SAM) and Global longitudinal strain. These parameters were evaluated at baseline and after LV myectomy at medium term (at least 6 months after surgery). Results They are followed for a mean of 3.4± 1.9 years after surgery. Eight patients underwent concomitant procedure; mitral valve repair and annuloplasty in 3 patients (10%), Maze surgery in 1 patient, LV aneurysmectomy in 2 patients and aortic valve replacement in 3 patients (10%). Patients with concomitant procedure were excluded from LV function analysis. Postoperative LVOTG were controlled in 10mmHg or less.Global longitudinal strain (GLS) improved but no significant change. Otherwise LA volume index decreased (from 52.5 ± 16.7 to 32.9 ± 14.6 ml/m2, p = 0.01) and LV diastolic function improved with an increase in lateral e" velocity (from 4.5 ± 2.8 to 9.2 ± 3.4 cm/sec, p = 0.001) and improved E/e’ (from 18.9 ± 5.6 to 10.6 ± 5.2, p <0.05). Symptoms of dyspnea, chest oppression and heart failure improved with reduction in the New York Heart Association functional class. Conclusion Excellent relief of LVOT obstruction in HOCM by surgical LV septal myectomy results in decreased LA volume and LV diastolic function with improved symptoms.

Left Ventricular Aneurysmectomy and Repair of Post-infarct Ventricular Septal Defect with Concomitant Aortocoronary Bypass Grafting: A Video Presentation

Mechanical complications resulting from myocardial infarction usually have profound acute or chronic hemodynamic effects. Left ventricular aneurysm formation and ventricular septal rupture occurs in 10-20% patients after acute myocardial infarction [1-6]. Surgical techniques have gradually evolved since the first successful operation for post-infarct ventricular septal defect was performed by Cooley and colleagues in 1956 [2,3,6].

343 - Recent Trends in Surgical Management of Heart Failure in the United States

Background: Despite advances in medical management, patients with end stage heart failure (ESHF) have limited options which includes various surgical procedures. Objective: Our aim was to identify the trend of some of the surgical procedures undertaken for ESHF in the United States from 2008–2014 using Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database. Methods: We identified patients who were hospitalized with diagnosis of heart failure using appropriate International Classification of Diseases—9th edition (ICD-9) codes. We then identified patients undergoing heart transplantation (HT), left ventricular assist device (LVAD) placement, left ventricular aneurysmectomy (LVA), partial left ventriculectomy (pLV), artificial heart (AH) and Acorn CorCap (ACC) implantation using appropriate ICD-9 codes. We used linear-by-linear association to assess any changes in the trends of these surgical procedures. Results: We identified a total of 30,293,070 hospitalizations with heart failure from 2008 to 2014. A total of 14425 HT were performed in these years. There has been an 18% increase in number of HT (P < .001) with 1990 HT performed in 2008 compared to 2360 HT in 2014. A total of 18718 LVAD were performed from 2008 to 2014. LVAD showed a threefold increase (P < .001) with 1244 LVAD in 2008 which increased to 3790 in 2014. LVA showed a 40% decrease in trend (P < .001) with 656 LVA done in 2008 compared to 395 in 2014. pLV or Batista procedure was done in a total of 401 patients. It showed a 77% decrease in trend (P < .001) with 158 pLV done in 2008 compared to 35 in 2014. AH was implanted in 546 patients and it showed approximately 4-fold increase (P < .001) with 19 implantations in 2008 which increased to 75 in 2014. A total of 349 ACC were implanted and it showed an 80% decrease in trend (P < .001) with 78 ACC procedure in 2008 compared to 15 in 2014. Conclusion: From 2008 to 2014, LVAD showed a significant increase in trend while HT showed a modest rise. Although the increase in trend of AH was statistically significant, it is still under-utilized. LVA, pLV and ACC implantation showed a significant decline in trend and are now done only in few selected cases.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Left apical aneurysm in a patient with severe aortic valve stenosis.

We report on a very rare case of left ventricular aneurysm in a 77-year-old patient with aortic valve stenosis and without coronary artery disease. The patient underwent conventional aortic valve replacement and left ventricular aneurysmectomy with an uneventful postoperative course. The cause of the left ventricular aneurysm was suspected to be a long history of aortic valve stenosis that led to severe intraventricular hypertension, subsequently asymmetric septum hypertrophy, and finally apical aneurysm.

Approximation of papillary muscles for ischaemic mitral regurgitation combined with coronary artery bypass grafting and left ventricular aneurysmectomy: a case report

A 72-year-old female presented with severe ischaemic mitral regurgitation following a recent myocardial infarction. She had no significant past medical history. Pre-operative echocardiogram assessment demonstrated preserved tendinous cords of the mitral leaflets, a mitral valve annulus measuring 3.2 cm with end systolic coaptation of 0.3 cm, impaired left ventricular function with an ejection fraction of 35% and significant ventricular dilatation. Cardiac magnetic resonance imaging (MRI) showed delayed enhancement in the anterolateral, septal and lateral walls and confirmed the impairment of the left ventricle and a large aneurysmal deformation. On-table transoesophageal echo showed that the distance between the two papillary muscles was over 4 cm. We performed coronary artery bypass grafting combined with a Dor Procedure and papillary muscle approximation using a polytetrafluoroethylene (PTFE) vascular graft as a sling, without the insertion of a mitral annuloplasty ring. Postoperative echo and cardiac MRI showed improved left ventricular systolic function and reduced left ventricle volume associated with mild mitral regurgitation. We conclude that papillary muscles approximation as a method of mitral valve repair is a very effective procedure for functional ischaemic mitral regurgitation.

Ventricular tachycardia in hypertrophic cardiomyopathy with apical aneurysm successfully treated with left ventricular aneurysmectomy and cryoablation

A 64-year-old woman with type II diabetes mellitus was admitted to our institution with incessant ventricular tachycardia. She reverted to sinus rhythm after treatment with intravenous amiodarone, but the tachyarrhythmia recurred days later. Coronary angiography showed unobstructed coronary arteries. Left ventriculography ( Panel A , Supplementary material online, Video S1 ) revealed apical ballooning with mid-ventricular obstruction, suggestive of either large left ventricular (LV) apical aneurysm or stress (Takotsubo) cardiomyopathy. Transthoracic …

Combined Cardiac Surgery and Endovascular Repair of Abdominal Aortic Aneurysms

To report an initial experience of concomitant endovascular repair of abdominal aortic aneurysms (AAA) and cardiac surgery. Records for 10 consecutive patients (all men; median age 68 years, range 60-79) with AAA treated by a multidisciplinary team at a tertiary specialist center were retrospectively reviewed. Each patient had independent indications for surgical correction of their cardiac disease and AAAs. The patients underwent endovascular aneurysm repair (EVAR) followed by cardiac surgery under the same anesthesia. Eight patients had concomitant coronary artery bypass grafting (CABG; 4 off-pump), 1 patient had CABG and left ventricular aneurysmectomy, and 1 patient required aortic root replacement. All combined procedures were performed successfully under a single general anesthesia and took a median of 508 minutes (range 425-625). Median intensive care stay was 3 days (range 2-4), while hospital stay was 8 days (range 7-21) days. There were no deaths in-hospital or within 30 days. Complications were minor and self-limiting; there were no instances of renal failure. At a median follow-up of 29 months (range 14-38), no EVAR-related secondary interventions were required. Concomitant EVAR and cardiac surgery delivered by a multidisciplinary team is feasible, appears safe, and eliminates the risk associated with staged operations. Improved patient satisfaction and efficient use of resources are potential advantages.

Sol Ventrikül Psödoanevrizması Olarak Algılanan Sol Akciğer Kitlesi

Left ventricular pseudo-aneurysm is a rare complication of aneurysmectomy. We present a case of surgically-treated left ventricular pseudo-aneurysm which was diagnosed three years after coronary artery bypass grafting and left ventricular aneurysmectomy. The presenting symptoms, diagnostic evaluation and surgical repair are described.

Anesthetic management for reentry sternotomy in a patient with a full stomach and pericardial tamponade from left ventricular rupture

A 57-year-old man presented with chest pain and shortness of breath 1 month after left ventricular aneurysmectomy and ventricular septal defect closure for post-infarct left ventricular aneurysm and ventricular septal defect. Echocardiography revealed a large recurrent ruptured inferior left ventricular aneurysm with high-velocity flow into a 5 cm posterolateral pericardial effusion. Thirty minutes earlier, the patient had eaten a full meal. Rapid sequence induction was performed with midazolam, ketamine, and succinylcholine. Moderate hypotension was treated effectively and the patient tolerated controlled transition to cardiopulmonary bypass. The ventricular defect was oversewn and reinforced with bovine pericardium. The patient had a difficult but ultimately successful recovery. Options for anesthetic management in the setting of tamponade and a full stomach are discussed, with a brief review of the evidence relating to this clinical problem.

Subepicardial aneurysm by venting catheter via the right superior pulmonary vein

Subepicardial aneurysm caused by a left ventricular venting catheter inserted from the right superior pulmonary vein is very rare. Generally, this type of aneurysm is a complication of acute myocardial infarction. We report a 76-year-old woman in whom a left ventricular aneurysm was shown by transthoracic echocardiography 3years after mitral valve replacement. She underwent left ventricular aneurysmectomy via the 4(th) left intercostal space. The left ventricular aneurysm was separated from the pericardium completely; therefore, this aneurysm was not thought to be pseudoaneurysm. The postoperative course was uneventful and the aneurysm was diagnosed as a subepicardial aneurysm from a histological examination.

Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients

Mitral valve repair has become the procedure of choice for almost every type of mitral regurgitation (MR) in the current surgical era. We assessed clinical outcomes of mitral valve repair in severe MR. In this prospective cohort study, 103 patients (61 male, 42 female, mean age 53.2±14.8 years), who were planned to undergo valve repair were included. Mitral valve pathology was regurgitant in 86% and mixed in 14% of patients. The intention to perform mitral repair was successful in 100 (97.1%) of patients. Concomitant procedures were performed in 57 (57%) patients including 31 coronary artery bypass grafting and 13 tricuspid valve repairs. After surgery, early (<30 days) and late (>30 days) complications were recorded. Postoperative echocardiography was performed in all patients at discharge and during clinical follow-up. Late survival and freedom from adverse events including thromboembolism, endocarditis, reoperation, and residual severe MR were estimated by using the Kaplan-Meier survival analysis. There was no early mortality. Echocardiographic assessment of patients at discharge revealed no/trivial regurgitation in 89% and mild (1+) MR in 11% of all patients. Late mortality occurred in only one patient at 14 months because of renal failure. The mean follow-up period of patients was 21.2±10.3 months. Echocardiographic examination during follow-up revealed that mitral insufficiency was none or mild in 96% of patients. Three (3%) patients had moderate (2+) MR and were treated medically. Mitral insufficiency recurrence with severe (3+) regurgitation occurred in one (1%) patient undergoing coronary artery revascularization and concomitant left ventricular aneurysmectomy. Re-operation was needed in only one (1%) case because of infective endocarditis that was treated with mechanical valve replacement. Kaplan-Meier estimates were 99±2.7% for late survival and 98±2.2%, 99±2.7%, 99±2.7% and 99±0.9% for freedom from thromboembolism, endocarditis, reoperation, and residual severe MR, respectively. This study showed that mitral valve repair provides excellent surgical outcomes. Repair procedures are safe, and highly effective, but operations require a considerable surgical experience.

Trans-apical aortic valve implantation in patients with severe calcification of the ascending aorta☆☆☆

In patients with calcification of the ascending aorta, postoperative stroke and mortality rates remain high after conventional aortic valve replacement, but the results of trans-apical aortic valve implantation in these patients are not known. We evaluate the outcome of trans-apical aortic valve implantation in patients with severely calcified ascending aorta in a single center with expanded procedural experience. Between April 2008 and July 2010, 258 patients underwent trans-apical aortic valve implantation using Edwards Sapien valve. By computed tomography (CT) scan, we identified 46 (18%) patients with severe calcification of the ascending aorta (16 with porcelain aorta and 30 with severe, but not complete, calcification). Of 46 patients (mean age 77 ± 10 years, range 63-90 years; EuroSCORE (European System for Cardiac Operative Risk Evaluation) 45 ± 22%; STS (Society of Thoracic Surgeons) score 23 ± 13) with calcified aorta, 15 received 23-mm valves and 31 patients 26-mm valves. Primary valve implantation was successful in 44 patients and a second valve was implanted (valve-in-valve) in two. Six patients underwent concomitant interventions (three elective percutaneous coronary intervention (PCI), one off-pump coronary artery bypass (OPCAB), one tricuspid valve reconstruction, and one left-ventricular (LV) aneurysmectomy). The final procedural results showed valve incompetence (trace or grade 1) in 17 (37%) patients and paravalvular leak in 15 (32.6%) (trace in 10 and grade 1 in five). There was no 30-day mortality. Postoperatively, cranial CT showed new cerebral ischemia areas in three patients (6.2%), but only one patient (2.1%) experienced postoperative neurological deficit (temporary aphasia). Survival at 6 and 12 months was 88% and 85.2%, respectively. Trans-apical aortic valve implantation can be performed safely in patients with aortic valve stenosis and severe calcification of the ascending aorta.

A Case of Implantation of ICD over 30 Years after CABG for Coronary Arterial Lesions Due to Kawasaki Disease

The patient was a 41-year-old male. In 1970, at 2 months of age, he was affected by Kawasaki disease; he suffered a broad anterior myocardial infarction at 7 months of age. When the patient was 7 years old, cardiac catheterization revealed a left ventricular aneurysm and left ventricular dysfunction (EF29%). Coronary angiography (CAG) revealed coronary artery aneurysm in the left main trunk and proximal right coronary artery (RCA), an occlusion in the left anterior descending artery (#6), and 75% stenosis in the distal portion of the RCA aneurysm. The left ventricular aneurysmectomy and CABG (SVG-RCA #3) were performed in 1978. A patent SVG was demonstrated by CAG when the patient was 8, 10, 15, and 26 years old. The EF of the left ventricle improved from 26% to 39%. The patient had been in NYHA I; however, ventricular tachycardia occurred in 2004 while he was hiking around Mt. Fuji. CAG showed favorable patency of the SVG, but ventricular fibrillation was induced. He had an implantable cardioverter defibrillator (ICD) implantation 34 years after myocardial infarction. There was no sustained VT observed afterwards and the ICD has not performed any defibrillation. This case shows that myocardial remodeling will cause lethal arrhythmia over 30 years after CABG even if with patent grafts.

Asymptomatic Left Ventricular Pseudoaneurysm Evaluated With Multimodality Cardiac Imaging

A 55-year-old man admitted with a 20-day history of intermittent chest pain. Electrocardiogram showed small Q wave and T wave inversion in the inferolateral leads. There were no specific findings on chest radiography (Fig. 1A). Echocardiogram showed akinesia and mild aneurysmal change of the left ventricular (LV) posterolateral wall (Fig. 1B). Coronary angiography demonstrated total occlusion of the mid left circumflex artery. Under the diagnosis of recent myocardial infarction, we performed aspiration thrombectomy and deployed two drug-eluting stents. Fig. 1 A 55-year-old man with asymptomatic left ventricular pseudoaneurysm. After an event-free 14-month follow-up period, we detected abnormal contour on repeat chest radiography (Fig. 1C). Echocardiography confirmed large out-pouching aneurysmal change of LV posterolateral wall with narrow neck containing hyperechoic thrombi (Fig. 1D).1-3) Multi-detector computed tomography revealed definite bulging-out contour of the LV wall (Fig. 1E).3) A fast, steady-state sequence of cardiac magnetic resonance imaging showed discontinuity of the myocardium and a bulging sac. The maximum width of the orifice was shorter than the maximum parallel internal diameter (Fig. 1F).4),5) On inversion-recovery-prepared breath-hold cine gradient-echo sequence, markedly delayed enhancement of the pericardium that forms the wall (white arrow), as well as linear hypointense thrombus were detected (Fig. 1G), which have been suggested as helpful additional features for differentiation between true and false LV aneurysms.4) Because of rupture risk, the patient was treated with LV aneurysmectomy. Following thoracotomy, we observed narrow-necked channel with a larger aneurysmal sac, which contains blood and thrombus (Fig. 1H). Histologic finding revealed fibrous pericar-dial tissue and thrombi with no myocardial elements. The patient remained complication free following the operation.

Do we need a pulmonary artery catheter in cardiac anesthesia? - An Indian perspective

There has been considerable controversy regarding the use of pulmonary artery catheter (PAC) in clinical practice. Some studies have indicated poor outcome in patients who were monitored with PAC. However, these studies, which have condemned the use of PAC, were conducted on patients in intensive care units, where the clinical scenarios with regard to patients' status are somewhat different as compared to those of a cardiac operating room. This study was designed to identify the indications of PAC use in cardiac operating rooms. A questionnaire was mailed to anasthesiologists in cardiac centers and the response was analyzed.The practicing cardiac anesthesiologists recommended the use of PAC for following indications in cardiac surgery: coronary artery bypass grafting (CABG) with poor left ventricular (LV) function, LV aneurysmectomy, recent myocardial infarction (MI), pulmonary hypertension, diastolic dysfunction, acute ventricular septal rupture and insertion of left ventricular assist device (LVAD).The analysis of responses from practicing anesthesiologists clearly indicates that use of a PAC cannot be recommended as a matter of routine, but a definite role is suggested in selected groups of patients undergoing cardiac surgery.

Surgical Treatment of Left Ventricular Aneurysm

When a left ventricular aneurysm leads to pulmonary congestive symptoms, aneurysmectomy may provide relief. This retrospective study included 269 patients who underwent aneurysmectomy between 1993 and 2002, by the classic Cooley operation in 164 and by Dor ventriculoplasty in 105. There were no significant differences in early and late survival between groups, although the frequency of extended anteroseptal infarction was higher in patients undergoing the Dor procedure. Postoperative echocardiographic findings showed significant improvements in left ventricular function in both groups, in terms of end-diastolic and end-systolic dimensions and ejection fraction. Left ventricular aneurysmectomy significantly improved the clinical status and hemodynamic parameters of symptomatic patients. The choice of surgical technique depends on the extent of the scar segment, especially the presence of an anteroseptal scarred area. The Dor procedure is more suitable for restoring normal left ventricular geometry in patients with extensive septal infarction.