Left ventricular aneurysm: pre- and postoperative haemodynamic studies at rest and during exercise

We studied 9 men with antero-apical left ventricular aneurysms. All suffered from incapacitating angina pectoris without heart failure. Aneurysmectomy was done in 4 patients as the sole procedure while it was combined with revascularisation of the residual myocardium in the other 5. Haemodynamic measurements were made at rest and during submaximal supine-leg exercise before and approximately 6 mth after operation in each patient. Compared to the preoperative levels, we observed a significant increase in respiratory rate at rest (P less than 0.001) and during exercise (P less than 0.01), in ventilation during exercise (P less than 0.05), in mean pulmonary arterial pressure at rest (P less than 0.001) and during exercise (P less than 0.01) and in mean pulmonary wedge pressure during exercise (P less than 0.01). These changes were accompanied by a significant reduction in cardiac output during exercise (P less than 0.01) and in stroke volume at rest (P less than 0.05) and during exercise (P less than 0.01). Heart rate and blood pressure remained essentially unchanged. . The curve representing the relationship between the left ventricular stroke work and the filling pressure shifted downwards and to the right after operation compared to that before operation. Patients who show only minimal haemodynamic disturbances associated with an aneurysm, maintain an effective forward stroke volume by an augmented fibre-shortening of the residual myocardium as well as an increase in the diastolic volume of the heart. Results of our study demonstrated that the compensatory ventricular dilatation may be critical in this group of patients. Despite an increase in average ejection fraction after operation, the removal of the aneurysm led to considerable haemodynamic deterioration in all the patients studied.