[Recurrent post-infarction ventricular tachycardias. Treatment combining circular ventriculotomy, myocardial revascularization and aneurysmal plication].

The efficacy of encircling endocardial ventriculotomy (EEV) with treatment of recurrent persistent post-infarction VT has been established. The relative simplicity of the operation has enables it to be easily integrated into the surgical therapeutic arsenal for the treatment of coronary artery disease and its complications. Several electrophysiological studies have clearly demonstrated the origin of reentry pathways in the border zone of the aneurysm so that peroperative mapping can be dispensed with except in special cases. Sixteen patients with post-infarction LV aneurysm causing recurrent VT resistant to antiarrhythmic therapy for over 3 months were operated between January 1979 and June 1983. The average age was 51 years, range 36 to 70 years. The causal myocardial infarction dated from 3 months to 22 years; the site of infarction was anterior in 12 cases (anteroseptal 5 cases), posterior in 3 cases and circumferential in 1 case. Surgery was performed under cardiopulmonary bypass and comprised EEV in the border zone of the aneurysm without prior mapping studies. A myocardial revascularisation procedure was associated in 10 cases (aortocoronary saphenous vein bypass) with single grafts in 4 patients. Thirteen patients also underwent plicature of the aneurysm to remodel the ventricular cavity. There was one death in the immediate postoperative period due to a low output state (6.25%). The 15 survivors have been followed up for 1 to 45 months during which period 3 deaths occurred, on at the 2nd month due to cardiac failure and 2 sudden deaths at the 5th and 22nd months. These 2 patients had not had recurrences of their arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)