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Surgical treatment of postinfarction false aneurysm of the left ventricle
Insights
Surgical repair of left ventricular false aneurysms offers good outcomes. However, patients requiring concurrent mitral valve replacement face higher mortality risks, impacting overall survival rates.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Devices
Background:
- Left ventricular false aneurysms (LVFA) are rare but serious complications following myocardial infarction.
- Clinical presentation often includes congestive heart failure, frequently in patients with multi-vessel coronary artery disease.
Purpose of the Study:
- To evaluate the surgical outcomes and long-term results of patients undergoing repair for left ventricular false aneurysms.
- To identify factors influencing patient survival after LVFA repair.
Main Methods:
- Retrospective analysis of twelve patients who underwent surgical repair of LVFA.
- Procedures included aneurysm resection with primary closure or patch repair, often combined with coronary artery bypass grafting and/or mitral valve replacement.
Main Results:
- The mean interval from myocardial infarction to diagnosis was 19 months. Posterior aneurysms were more common (10/12 patients).
- Eight patients survived with good outcomes after a mean follow-up of 62 months.
- All three operative deaths and one late death occurred in patients who also required mitral valve replacement.
Conclusions:
- Surgical repair of left ventricular false aneurysms can lead to favorable long-term outcomes.
- The necessity of concomitant mitral valve replacement significantly increases operative risk and mortality.
Abstract:
Twelve patients underwent surgery for repair of false aneurysms of the left ventricle. The mean interval between the myocardial infarction and the diagnosis was 19 months (range 2 to 80 months). Congestive heart failure was the most common clinical presentation. Most patients had three-vessel coronary artery disease. The false aneurysm was posterior in 10 patients and anterior in two. Three patients with posterior aneurysm had severe mitral regurgitation. Repair was accomplished by resection of the false aneurysm and primary closure of the defect in four patients and by closure with a patch in eight. Nine patients also had coronary artery bypass. Mitral valve replacement was performed in three patients who had severe mitral regurgitation before the operation and in one patient who had severe mitral regurgitation after repair of the false aneurysm and could not be weaned from cardiopulmonary bypass. There were three operative deaths and one additional death after 2 months. All deaths occurred in patients who had mitral valve replacement. Eight patients survived the operation and remained well after a mean follow-up period of 62 months. Patients with false aneurysms of the left ventricle do well after surgical repair, except when concomitant mitral valve replacement is necessary.