Surgical experience with postinfarction ventricular aneurysm

Fifty-eight patients had surgical treatment of postinfarction ventricular aneurysm. Resection was performed in 47 patients and plication in 11. There were 44 combined procedures, mostly myocardial revascularizations. Indications for operation included congestive heart failure, angina, arrhythmias, and thromboembolic phenomena. All aneurysms were documented by cineventriculography, and 54 patients had coronary cineangiograms. Left ventricular end diastolic (LVED) pressures ranged from 25 to 50 in 25 of the patients but did not affect mortality. Hospital mortality (14% overall) was directly proportional to degree of coronary artery disease--single vessel, 0; double vessel, 10%; triple, 24%. Nine patients are alive more than six months postoperatively and 37 are alive from six months to eight years postoperatively. We conclude that aneurysmectomy is the procedure of choice for ventricular aneurysms that are hemodynamically significant or have produced ventricular clots, arrhythmias, or embolic phenomena. An LVED of greater than 25 mm Hg does not contraindicate operation, but triple vessel coronary disease increases the risk.