J.Jpn. Surg. Soc.. 82(10): 1199-1204, 1981

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Original article

SURGICAL TREATMENT OF POSTINFARCTION VENTRICULAR ANEURYSM RETROSPECTION OF POSTOPERATIVE LONG-TERM RESULTS

Fourteen patients had resection of a chronic postinfarction left ventricular aneurysm. Seven patients had coronary bypass grafting in addition to aneurysmectomy. The operative mortality rate was 7% (1/14) and late mortality (mean follow-up 69.9 months, range 32 to 96 months) 7.7% (1/13). Postoperatively almost patients achieved N Y H A functional Class I status. However, in one patient angina pectoris reapeared after 1 year postoperatively, and 2 had new myocardial infarction after 5 and 8 years respectively.
The function of the residual contracting left ventricle, ejection fraction and mean percent shortening of transvers axis, correlated well with the patient's postoperative functional capacity. When the aneurysm involved the anterior portion of the interventricular septum, the left ventricular end-diastolic volume did not reduce postoperatively, but EF and mean percent shortening of transvers axis made no significant difference between involvement of the septum and non-involvement. Aneurysmectomy in combination with coronary bypass grafting improved a better functional capacity than aneurysmectomy alone. Aneurysmectomy is safe and effective, therefore, we consider that the asymptomatic aneurysm should be resected before the residual contractive ventricle become worse. We ought to exclude as much as possible non-contractive tissue except a margin of fibrotic scar for placement of sutures. Complete myocardial revascularization and restoration of near normal left ventricular volumes produce a better postoperative functional capacity.

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