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[Radiological diagnosis of ventrycular aneurysms. A report on 36 operated cases (author's transl)]
Insights
Radiological exams like ventriculography and coronarography are crucial for diagnosing left ventricular aneurysms after heart attacks. These imaging techniques help identify operable aneurysms and guide surgical selection, leading to good patient outcomes.
Area of Science:
- Cardiology
- Radiology
- Cardiac Surgery
Background:
- Left ventricular aneurysms are a serious complication following myocardial infarction.
- Accurate diagnosis is essential for determining appropriate surgical intervention.
- Assessing the efficacy of various radiological examinations is key to improving patient selection for surgery.
Purpose of the Study:
- To evaluate the diagnostic value of different radiological examinations for left ventricular aneurysms post-infarction.
- To correlate radiological findings with surgical outcomes in a cohort of patients.
- To identify key imaging signs indicative of operable aneurysms.
Main Methods:
- Retrospective analysis of 36 operated cases with left ventricular aneurysms.
- Correlation of findings from standard radiological examinations, ventriculography, and coronarography with surgical results.
- Assessment of anatomical and dynamic changes visualized through ventriculography.
- Evaluation of coronary artery involvement using coronarography.
Main Results:
- Standard examinations revealed cardiomegaly and irregular heart borders; myocardial calcification was less common.
- Ventriculography demonstrated anatomical protrusions or dynamic changes (hypokinesia, akinesia, systolic expansion) in aneurysms, predominantly anterior/anterolateral (87%).
- A critical cardiac surface area of approximately 25% was identified as a threshold for operability.
- Coronarography indicated significant involvement of the anterior interventricular artery (90%) in aneurysm cases.
- The combined use of ventriculography and coronarography facilitated patient selection for surgery.
Conclusions:
- Ventriculography and coronarography are essential radiological tools for diagnosing and assessing left ventricular aneurysms.
- These imaging modalities enable precise identification of operable aneurysms and guide surgical candidacy.
- Surgical intervention based on radiological assessment yielded favorable outcomes, with reduced arrhythmias and improved cardiac insufficiency symptoms.
Abstract:
The value of different radiological examinations in the diagnosis of left ventricular aneurysms following infarcts is assessed using the results obtained in 36 operated cases. By correlating radiological and surgical findings the orientation value of standard examinations can be determined: almost constant cardiomegaly, irregularity of the borders of the heart, and more rarely, myocardial calcification, are significant signs. The two essential examinations are ventriculography and coronarography. Ventriculography can demonstrate anatomical abnormalities (protrusion), or dynamic changes only (hypokinesia, akinesia, systolic expansion). This remarkably reliable examination showed a predominance of anterior and anterolateral aneurisms (87% of cases), and enables definition of the critical cardiac surface area (about 25%) above which the aneurysm is operable. Coronarography shows that the anterior interventricular artery (A.I.V.) is affected in a large proportion (90%) of aneurysms. These two examinations can be used to select those patients suitable for surgery. Results were good and only one death occurred. In the other cases, the disorders of rhythm were reduced and the manifestations of cardiac insufficiency disappeared.