[Longterm prognosis of 27 patients with left ventricular aneurysm and conservative treatment (author's transl)]
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Conservative treatment for left ventricular aneurysms offers a good long-term prognosis for many patients. Close patient-physician contact and risk factor management appear crucial for managing these cardiac conditions.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Context:
- Left ventricular aneurysms are a potential complication following myocardial infarction.
- Surgical intervention for these aneurysms carries significant risks and costs.
Purpose:
- To evaluate the long-term outcomes of conservative management for left ventricular aneurysms.
- To identify predictors of complications and assess the overall prognosis.
Summary:
- A 42-month follow-up of 27 patients with conservatively treated left ventricular aneurysms revealed low mortality (11%) and manageable heart failure rates (12.5%).
- While exercise tolerance decreased, most patients maintained a near-normal quality of life.
- Predicting severe complications like sudden death or heart failure proved difficult using available data.
Impact:
- Conservative management is often the preferred approach for left ventricular aneurysms due to high surgical mortality and costs.
- Close patient-physician communication and risk factor monitoring are vital for favorable long-term outcomes.
- Further research is needed to identify reliable predictors for severe complications.
Abstract:
The results of a follow-up study (mean 42 months after infarction) of 27 patients with conservatively treated left ventricular aneurysms showed: 1. 3/27 patients died of sudden death. Only one of these three could be predicted (ventricular fibrillation during exercise). 2. 3/24 remaining patients developed congestive heart failure. This could be predicted in one patient because of global hypocinesia of the left ventricle. 3. The exercise tolerance (Swan-Ganz) of the remaining 21 patients decreased from approximately 100 to 70 watts. Thus, all patients were able to lead an almost normal live. 4. Therefore conservative treatment of left ventricular aneurysms in most cases is the method of choice, since high surgical mortality, financial burdens of the society and man power has also to be considered. 5. The development of complications which would lead to aneurysmectomy (sudden death, life threatening arrhythmias, embolisation, congestive heart failure) cannot be foreseen from history, non-invasive and invasive data. 6. The close "patient to physician-contact" (risk-factors, medication) may have influenced the relatively good long-term prognosis of this group.