[Aneurysmectomy and revascularization in high-grade ventricular insufficiency following myocardial infarct]

A 58-year-old man sustained an anterior-wall myocardial infarction (without significant prodromal symptoms) and, two weeks later, a re-infarction with development of an extensive anterior-wall aneurysm. Rapidly progressive myocardial insufficiency with massive impairment of left-ventricular ejection fraction (7%), coronary angiography demonstrating triple vessel disease, necessitated resection of the aneurysm and double aortocoronary bypass. The patient was well enough for transfer to the rehabilitation unit on the 11th postoperative day. After a follow-up period of 50 months he was symptom-free with moderate exercise tolerance (NYHA class II). At ergometry he performed at 41% of expected, and echocardiography recorded a left-ventricular ejection fraction of 19%. Aneurysm resection is the treatment of choice in such cases. It is associated with a low perioperative mortality rate so that 5-year survival rate is clearly greater than with conservative treatment.