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Pierre Theodore
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Ann Thorac Surg 1992;54:617-620
© 1992 The Society of Thoracic Surgeons

Articles

Dose a posterior aneurysm increase the risk of endocardial resection?

Irving L. Kron, MD*, John A. Kern, MD, Pierre Theodore, BA, Terry L. Flanagan, MPH, David E. Haines, MD, Michael J. Barber, MD, John P. DiMarco, MD, PhD

Division of Thoracic and Cardiovascular Surgery and Division of Cardiology, University of Virginia Health Sciences Center, Charlottesville, Virginia, USA

* Address reprint requests to Dr Kron, Department of Surgery, University of Virginia Health Sciences Center, Box 310, Charlottesville, VA 22908.

The bias has been that the ideal anatomic circumstance for endocardial resection is the anterior left ventricular location. Posterior left ventricular aneurysms have been thought to be problematic to map and more difficult to close, and possibly to have a different substrate for ventricular tachycardia. To address this problem, we retrospectively reviewed the cases of 110 consecutive patients who underwent sequential endocardial resection for ventricular tachycardia between 1983 and 1991. Ninety-six patients had an anterior aneurysm, and 14 patients had a posterior aneurysm or infarct. Operative survival and 5-year survival were very similar between the two groups (p = not significant). A positive postoperative electrophysiological study was present in 11% of the anterior group versus 14% of the posterior group (p = not significant). There was a significantly greater incidence of mitral valve replacement in the posterior group, and we believe this was most likely due to frequent localization of the arrhythmia to the papillary muscle. Otherwise, patients with a posterior aneurysm or infarct had surgical results equivalent to those in patients with an anterior location. As long as there is a discrete aneurysm or infarct, endocardial resection is a safe and effective therapeutic procedure for ventricular tachycardia.




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