[Left ventricular aneurysmectomy: technical evolution and results]

A critical review of surgical techniques for left ventricular aneurysm treatment, with reference to literature data and author's personal experience, is reported. Aneurysm plicatio, performed in 35 patients, was always associated to coronary artery bypass graft and carried out mainly in small aneurysms of the posterior wall. In the last years this technique has been used very rarely, due to papillary muscle damage risk. Aneurysmectomy by usual technique only partially eliminates the a-dyskinetic area and moreover determines a severe ventricular deformation due to the linear suture. At Verona hospital it was carried out in 175 patients, with an 8% operative mortality and a survival rate of 82% at 3 years and of 80% at 5 years. Aneurysmectomy with converging walls left ventricular reconstruction, as proposed by Jatene and modified by the author, allows complete aneurysm removal and assures a ventricular reconstruction closer to normal morphology. In the Verona experience with this technique, referring to 51 patients operated up to 1989, operative mortality was 3.9% with a 89.9% survival rate at 3 years. These improved clinical results are associated with the improvement of left ventricular function indexes: average ejection fraction from 28.2% preoperatively to 42% postoperatively; average end diastolic left ventricular pressure from 23.6 mmHg to 18 mmHg.