[Clinical course of patients with aneurysms of the left ventricle following conservative and surgical therapy].

The angiographic and hemodynamic findings as well as the symptoms of a total of 128 patients (mean age 45, range 22 to 67 years) with left ventricular aneurysm were investigated retrospectively. The patients were assigned to three groups: Group op (69 patients): aneurysmectomy with and without revascularisation; Group kons-op (28 patients): indication for surgery, but operation not performed; Group kons (31 patients): no indication for operation. The size of the aneurysm was not significantly different in the three groups. Patients of group op and kons-op revealed more two- and three-vessel diseases than patients of group kons. Heart rate and left ventricular systolic pressure were not significantly lower than in the other groups which showed no significant difference. Enddiastolic volume differed not significantly in all groups, endsystolic volume was significantly lower in group kons than in group kons-op. Hence ejection fraction was significantly higher in group kons. The circumferential fiber shortening velocity in the residual part of the contracting ventricle was not different in all groups. Hemodynamic studies during exercise with pressure measurements in the pulmonary artery (floating catheters) revealed a significantly higher work load and a smaller increase of mean pulmonary artery pressure in group kons than in the other groups. In group kons the clinical symptoms (angina pectoris, dyspnea) were less distinct. The surviving patients of the medically treated groups showed no changes between the first and last clinical examination, whereas patients of group op revealed a significant improvement after surgery. Mortality was 13% in the group op, four patients died perioperatively. In Group kons-op the mortality was 50% during the observation period, in group kons only two patients died. In most cases the patients died for cardiac reasons. The results show that surgery is indicated in patients with left ventricular aneurysm with severe clinical symptoms, pathological hemodynamics at rest and/or during exercise not only because of the symptomatic improvement after surgery, but also because of the high mortality rate in patients without operation.