Postinfarction ventricular aneurysmectomy

Most operations performed for the treatment of ventricular aneurysm do not achieve maximal rehabilitation of the damaged heart. Cardiac surgeons generally ignore the importance of the flail septum that results from anteroseptal infarction. Many believe that the obstructed left anterior descending coronary artery must be carefully avoided during closure of the ventriculotomy incision. In addition, many surgeons believe that it is necessary to buttress all ventricular sutures with Teflon. For some reason, there seems to be a fear that the left ventricular volume will be reduced to an intolerable level after proper ventricular aneurysmectomy. Between January 1976 and December 1982, 102 patients underwent ventricular aneurysmectomy at St. Joseph's Hospital Health Center. The hospital mortality rate was 5.9 percent. The operative technique described emphasizes the need for foreshortening the fibrosed septum in an effort to minimize residual paradoxic motion. The left anterior descending coronary artery is routinely incorporated in the eversion technique; Teflon buttressing is never employed. Our surgical technique has evolved from a surgical experience that began in 1962 at the Cleveland Clinic Hospital.