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Updated: Aug 5, 2026
Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Left ventricular aneurysm: pre- and postoperative haemodynamic studies at rest and during exercise
Insights
Surgical removal of left ventricular aneurysms in patients with angina led to significant hemodynamic deterioration. Compensatory ventricular dilatation is critical for maintaining cardiac function in these patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Physiology
Background:
- Left ventricular aneurysms can cause incapacitating angina pectoris.
- Patients with these aneurysms may have minimal heart failure but significant symptoms.
- The compensatory mechanisms for maintaining cardiac output in the presence of aneurysms are not fully understood.
Purpose of the Study:
- To evaluate the hemodynamic effects of aneurysmectomy in patients with antero-apical left ventricular aneurysms.
- To assess the impact of aneurysm removal, with or without myocardial revascularization, on cardiac function.
- To determine the role of compensatory ventricular dilatation in patients undergoing aneurysmectomy.
Main Methods:
- Studied 9 male patients with antero-apical left ventricular aneurysms and severe angina.
- Performed hemodynamic measurements at rest and during supine-leg exercise before and after surgery.
- Compared outcomes of aneurysmectomy alone versus aneurysmectomy combined with myocardial revascularization.
Main Results:
- Aneurysmectomy resulted in increased respiratory rate, ventilation, and pulmonary pressures.
- Significant reductions in cardiac output and stroke volume were observed post-surgery.
- The left ventricular stroke work-filling pressure relationship shifted unfavorably after operation.
- Despite increased ejection fraction, overall hemodynamics deteriorated in all patients.
Conclusions:
- Compensatory ventricular dilatation is crucial for maintaining forward stroke volume in patients with left ventricular aneurysms.
- Aneurysmectomy, even with improved ejection fraction, can lead to significant hemodynamic compromise.
- Surgical intervention requires careful consideration of the potential negative hemodynamic consequences.
Abstract:
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.
