[Left ventricular aneurysm. The surgical results and follow-up]

From May 1988 through October 1994, 44 patients with ischemic left ventricular aneurysm were operated upon. The mean age was 60.5 +/- 7.7 years and 36 patients (81.8%) were male. Thirty-two patients (72.7%) had congestive heart failure in NYHA class II or greater and 26 (59.1%) had moderate or severe left ventricular dysfunction. In 41 cases (93.2%) there was a history or electrocardiographic signs of myocardial infarction and only 3 patients (6.8%) were angina free. The location of the aneurysms was antero-apical or antero-lateral in 37 patients (84.1%) and inferior in 7 (15.9%), and intracavitary clot was present in 9 cases (20.5%). Fifteen patients (34.1%) were operated upon using standard linear repair, 8 (18.2%) by Stoney's technique and in the remaining 21 (47.7%) an endoventricular patch plasty was performed. All patients but one had CABG with a mean of 2.7 grafts per patient. The IMA was used in all patients with graftable LA disease (90.0%). Double IMA grafting was used in 10 patients (22.7%). Three patients (6.8%) had associated valvular surgery. Hospital mortality was 2.3% (1 patient) and morbidity 22.7% (10 patients); intra-aortic balloon counterpulsation was required in two patients. The mean time of hospitalization was 13.5 +/- 9.0 days. In the follow-up period (mean 29.2 +/- 21.5 months), 6 patients had required hospitalization (left ventricular failure -4; supraventricular arrhythmia-2) and two died. The remaining 32 survivors (78.0%) are in functional class I of the NYHA, without angina. Surgery of left ventricular ischaemic aneurysm was possible with low mortality and morbidity, with good functional results.