Functional significance of electrocardiographic changes after left ventricular aneurysmectomy

Electrocardiographic (ECG) changes after left ventricular aneurysmectomy were analyzed in 20 patients, thirteen of whom had additional aorto coronary saphenous vein bypass surgery. ECG changes were correlated with postoperative clinical and hemodynamic results. Out of 14 patients (Group I) who showed hemodynamic and/or clinical improvement, eight had decrease of chronic ST segment elevation that was associated in five with loss of pathologic Q waves. In the remaining six patients (Group II) who showed no hemodynamic or clinical improvement as well as in six patients in Group I, chronic ST segment elevation persisted or increased and in some, new pathologic Q waves developed after surgery. The study suggests that loss of pathologic Q waves and/or decrease of chronic ST segment elevation in patients who undergo a left ventricular aneurysmectomy with aorto coronary saphenous vein bypass surgery may reflect postoperative clinical, hemodynamic and angiographic improvement. On the other hand, failure of these ECG changes to occur or, conversely, increased ST segment elevation and/or appearance of new Q waves may have no predictive value. The mechanisms for these ECG changes are discussed.