Surgical treatment of postinfarction left ventricular aneurysm in 32 patients

Thirty-two patients with large postinfarction left ventricular aneurysms shown at operation to consist of fibrous tissue are reported. All had angina and/or breathlessness, and none had a history of embolism. Thirty were correctly diagnosed by left ventricular cineangiography. Two of the 3 patients with inferior and 1 with an anterior had associated ventricular septal defects, and 3 patients with anterior aneurysm had mitral regurgitation. All had major coronary arterial lesions and 68 per cent had double or triple vessel disease. The aneurysm was excised in all patients; in 15 this was combined with saphenous vein bypass grafting of coronary arteries supplying surviving myocardium, in 3 with closure of a ventricular septal defect, and in 3 with mitral annuloplasty or replacement. Operative mortality was 6-2 per cent, and 79 per cent of the survivors are asymptomatic with average follow-up period of 18 months after operation. Postinfarction ventricular aneurysm has been shown to have a poor prognosis (Schlichter, Hellerstein, and Katz, 1954). In addition patients often suffer from exertional dyspnoea associated with a high left ventricular end-diastolic pressure, and from angina due both to increased wall tensio