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Ann Thorac Surg 1993;56:242-252
© 1993 The Society of Thoracic Surgeons

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Articles

Linear left ventricular aneurysmectomy: Modern imaging studies reveal improved morphology and function

Section of Cardiothoracic Surgery, Department of Diagnostic Imaging, and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut USA

^_* Address reprint requests to Dr Elefteriades, Section of Cardiothoracic Surgery, Yale University, 121 FMB, 333 Cedar St, New Haven, CT 06510.

It remains uncertain whether left ventricular aneurysmectomy (LVA) improves ventricular function and whether LVA improves or distorts left ventricular contour. we applied the powerful imaging techniques of multiple-gated acquisition scanning, intraoperative transesophageal echocardiography, and magnetic resonance imaging to assess functional and morphologic changes after LVA in 75 consecutive patients undergoing LVA by conventional resection and linear closure. fifty-two patients (69%) underwent concomitant coronary artery bypass grafting, 25 (33%) had directed endocardial resection, and 4 (5%) had valve replacement. the hospital mortality rate was 6.7% ([equation]). Actu arial survival rates were 86%, 80%, and 64% at 1 year, 2 years, and 5 years, respectively. Mean anginal class improved from 3.49 to 1.24 (p < 0.0001). Mean congestive heart failure class improved from 3.04 to 1.70 (p < 0.0001). by multiplegated acquisition scan (48 patients), mean ejection fraction improved from 0.25 preoperatively to 0.33 postoperatively (p < 0.0001). intraoperative transesophageal echocardiography (28 Patients) revealed no cases of distortion and demonstrated normalization of left ventricular contour in 69% of patients. Mean wall motion score improved from 16.4 to 18.8 (p < 0.001). Mean crosssectional area of the left ventricle decreased from 18.7 cm² to 12.8 cm² (p < 0.006). Magnetic resonance imaging confirmed normalization of left ventricular contour without distortion. We conclude that linear LVA is clinically effective and objectively improves left ventricular morphology and function. On this basis, we have extended application of LVA to include patients with at least moderate-sized aneurysms undergoing coronary artery bypass grafting, despite the absence of traditional indications of arrhythmia, embolism, and frank congestive heart failure.

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