Chronic false aneurysms of the left ventricle: management revisited.

False aneurysms of the left ventricle are a rare complication of myocardial infarction. They pose a high risk of cardiac rupture and death in the immediate stages following infarction. The long term fate of these aneurysms is less clear. Based on early reports, the current practice is to resect all false aneurysms regardless of their age. Three patients were found to have false aneurysms several years (seven to 12) following their index infarction. Two of the patients were asymptomatic at presentation and their aneurysms were discovered by echocardiography. All three patients underwent successful surgical repair. The literature on false aneurysms is reviewed and analyzed. With the wide availability of high quality noninvasive imaging there has been an increase in the reporting of unsuspected false aneurysms in the past decade. The need for prophylactic aneurysectomy of stable asymptomatic chronic false ventricular aneurysms is not well supported by available data in the literature. A strategy of conservative management with noninvasive follow-up may be a more appropriate alternative.