Postinfarction ventricular aneurysm.

Abstract

Postinfarction ventricular aneurysm may present as a dyskinetic or as an akinetic segment, depending upon the presence or absence of intraluminal thrombus. The overwhelming majority of aneurysms are localized to the anteroseptal portion of the left ventricle, while relatively few involve the diaphragmatic surface of the left ventricle. The introduction of extracorporeal circulation has offered a realistic form of surgical therapy for this serious complication of occlusive coronary disease. Proper surgical treatment involves excision of the aneurysmal wall and reconstruction of the ventriculotomy in such a way as to foreshorten the fibrosed portion of the interventricular septum. The technique described greatly alleviates residual paradox, which may be significant after conventional aneurysmectomy. The most impressive feature of ventricular aneurysmectomy concerns long-term survival. The natural history of the disease suggests that less than 20% of patients with ventricular aneurysm live five years after the initial infarction. In contrast, 76% of the first 400 consecutive aneurysmectomy patients operated on by the Cleveland Clinic team were alive four years after operation.