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[Surgical treatment of postinfarctual left ventricular aneurysm (author's transl)]
Insights
Surgical repair of left ventricular aneurysms after myocardial infarction improves survival. Operative technique significantly impacts mortality, highlighting the importance of surgical approach in managing this complication.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Research
Context:
- Left ventricular aneurysm is a common complication following myocardial infarction.
- The diagnostic and prognostic implications of ventricular aneurysms require further clarification.
- This study analyzes a surgical series of 66 patients undergoing ventricular resection for symptomatic left ventricular aneurysm.
Purpose:
- To analyze the outcomes of surgical intervention for symptomatic left ventricular aneurysms.
- To investigate the correlation between clinical factors, surgical findings, and mortality.
- To evaluate the impact of operative technique on patient survival.
Summary:
- The study included 66 patients with symptomatic left ventricular aneurysms, with indications for surgery including angina, heart failure, and arrhythmias.
- Surgical findings revealed true aneurysms in 55 cases and akinetic wall areas in 11; 24 cases had endocavitary thrombosis.
- Surgical mortality was 7.5%, with 1-year and 5-year survival rates of 88% and 78%, respectively. Operative technique showed a significant correlation with mortality.
Impact:
- This research provides insights into the surgical management of left ventricular aneurysms.
- Findings emphasize the critical role of operative technique in improving patient outcomes and survival.
- The study contributes to defining diagnostic criteria and surgical indications for ventricular aneurysms.
Abstract:
Ventricular aneurysm is a frequent complication of myocardial infarction, but its diagnostic and prognostic implications are not fully defined. A surgical series of 66 ventricular resections for symptomatic left ventricular aneurysm is analyzed. Pts. age varied between 26-29 years; the interval between the episode of infarction and operation from 2 mos. to 12 years. Indication for surgery was angina in 53% of the cases, heart failure in 23%, arrhythmias in 15%, angina and failure in 9%. In 55 cases surgical findings were consistent with true aneurysm in the anatomical sense, in 11 cases with a wide area of wall akinesia. In 24 cases endocavitary thrombosis was present. In 23 cases aneurysmectomy was the only surgical procedure, with closure of acquired VSD in 1 case and mitral valve prosthesis in 2 cases. In 43 cases aorto-coronary bypass grafting was associated (single bypass in 18, double in 23, triple in 2). Operative technique underwent modifications in time, in relation to the use of local and general hypothermia, of cardioplegia, of early aortic cross-clamping. Surgical mortality was of 7.5% (5 cases); the actuarial courve, including operative mortality, showed survival of 88% at 1 year and of 78% at 5 years interval. Correlation between mortality and clinical symptomatology, hemodynamic data and surgical findings was not statistically significant; a statistically highly significant correlation was found between mortality and operative technique. The results are interpreted and discussed in relation to the diagnostic definition of the problem, to the criteria of indication to surgery and to the operative technique.