CASE REPORT Ventricular Aneurysmectomy for Recurrent

Ventricular aneurysm is a well-documented com-plication of myocardial infarction. The usual indi-cations for surgical removal of an aneurysm include congestive cardiac failure or thrombo-embolic epi-sodes refractory to medical treatment. In a review of the published reports we could find no report of any aneurysm being removed for the control of arrhythmias. We wish to report a case of a patient with recurrent refractory tachycardias which were eventually controlled by the surgical removal of the aneurysm. Case Report The patient, a 64-year-old woman, was first seen in October 1965, having been referred with a tachycardia of 11 days ' duration. For 2 years she had suffered chest pain and occasional palpitations. Clinically, she showed the signs of mild congestive cardiac failure and her blood pressure was 115/90 mm. Hg. Her pulse was regular at 156 a minute, and there was no response to carotid sinus pressure. The electrocardiogram showed a slightly irregular tachycardia with the QRS 0-12 sec. (Fig. la). After direct current countershock, the patient reverted to sinus rhythm. The electrocardiogram (Fig. lb) then showed an extensive anterior infarction with ST eleva-tion. The chest x-ray showed pulmonary congestion, cardiac enlargement, and a ventricular aneurysm, with calcification on the anterior aspect of the left ventricle (Fig. 2). She was discharged on digoxin 0-25 mg. twice a day, propranolol 10 mg. every 6 hours, and procain-amide 250 mg. every 6 hours. She was readmitted in January 1967, with a 3-day history of tachycardia. She had continued on medica-tion, but propranolol had been discontinued in October 1966. Direct current countershock reversion produced ventricular asystole, but she was resuscitated to sinus rhythm. The electrocardiogram was unchanged from that of October 1965. Tachycardia recurred the next day. Further direct current countershock wa