[Left ventricular aneurysms. Prognostic study. Operative results].

Eighty three patients with symptomatic post-myocardial infarction left ventricular aneurysms (cardiac failure: 62 cases; angina; 41 cases; ventricular arrhythmias: 37 cases; systemic embolism: 8 cases) underwent surgery between 1975 and March 1981. Preoperative investigations comprised clinical examination, left heart catheterisation and ventriculography. End systolic and end diastolic volumes, ejection fraction velocity of circumferential fibre shortening, and the akinetic surface area were calculated firstly for the whole of the left ventricle and then for the contractile zones after hypothetical resection of the aneurysm. Selective coronary angiography was carried out in 75 patients. The results were as follows: 16 perioperative fatalities (19.2 p. 100): Group IA; 14 late deaths or not improvement after surgery (17 p. 100): Group IB; 53 patients had little or no symptoms after surgery (63 p. 100), Group II. The 5 year survival rats is 69.7 p. 100. Severe cardiac failure (Stages III or IV of the NYHA Classification) is associated with a poor prognosis (33 p. 100 mortality). The hemodynamic parameters of the whole ventricle (end diastolic volume, global ejection fraction) had little or no correlation with the outcome. The ejection fraction of the contractile zones was significantly lower in Groups IA and IB (0.39 +/- 0.08, and 0.41 +/- 0.05) than in Group II (0.51 +/- 0.05), p less than 0.001). When the ejection fraction of the contractile zone exceeded 0.45, good results were obtained in 90 p. 100 of cases. The velocity of circumferential fibre shortening was also a good prognostic index (0.63 +/- 0.18 in Group IA compared to 1.10 +/- 0.09 in Group II, p less than 0.001). On the other hand, the diastolic volume of the contractile zone was very variable in all three groups. Extensive coronary artery disease not treated surgically worsened the prognosis (50 p. 100 mortality in triple vessel disease.) Seven of the 8 patients operated during the acute phase of myocardial infarction (less than I month) died, but they all had very poor hemodynamic parameters.