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[Left ventricular aneurysms. Prognostic study. Operative results].

L Ledain, J Hajj, J P Colle

Archives Des Maladies Du Coeur Et Des Vaisseaux

|September 1, 1982

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Surgery for post-myocardial infarction left ventricular aneurysms can improve symptoms, but prognosis depends on the ejection fraction of the contractile zone. A higher ejection fraction in these areas indicates better outcomes after surgical repair.

Area of Science:

Cardiology
Cardiac Surgery
Cardiovascular Research

Background:

Symptomatic left ventricular aneurysms following myocardial infarction present significant challenges.
These aneurysms are associated with heart failure, angina, arrhythmias, and embolism.

Purpose of the Study:

To evaluate surgical outcomes for patients with post-myocardial infarction left ventricular aneurysms.
To identify predictors of successful surgical intervention and long-term survival.

Main Methods:

Eighty-three patients with left ventricular aneurysms underwent surgical repair between 1975 and 1981.
Preoperative assessments included clinical evaluation, cardiac catheterization, ventriculography, and coronary angiography.
Hemodynamic parameters, including ejection fraction and velocity of circumferential fiber shortening, were analyzed for both the whole ventricle and contractile zones.

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Main Results:

The study reported a 5-year survival rate of 69.7%.
Patients with severe cardiac failure (NYHA Stages III-IV) had a higher mortality rate (33%).
Ejection fraction of contractile zones (0.51 +/- 0.05 in improved group vs. 0.39-0.41 in unimproved groups) and velocity of circumferential fiber shortening were significant predictors of outcome. Good results were achieved in 90% of cases when contractile zone ejection fraction exceeded 0.45.

Conclusions:

Surgical intervention for left ventricular aneurysms can lead to significant symptom improvement and survival.
The ejection fraction of the contractile zone and velocity of circumferential fiber shortening are crucial indicators for predicting surgical success.
Extensive untreated coronary artery disease and acute surgical phase (<1 month post-MI) negatively impact prognosis.