Clinical Profile and Outcome of Patients with Chronic Postinfarction Left Ventricular False Aneurysm Treated Surgically
Background: Rupture of the left ventricular (LV) free wall is usually fatal. In rare instances, hemorrhage is confined, and a false aneurysm (pseudoaneurysm) forms. In this study we reviewed our experience with patients treated surgically for chronic LV pseudoaneurysm.
Methods: Between 1997 and 2001, pseudoaneurysm was diagnosed in 8 patients (6 men and 2 women) 55.9 ± 7.6 years of age, and the patients underwent surgery. Before operation electrocardiogram (ECG), chest x-ray, echocardiography, and cardiac catheterization were performed. Repair was accomplished by resection of the pseudoaneurysm with use of cardiopulmonary bypass and in moderate systemic hypothermia (263C-283C). In 3 cases coronary artery bypass grafts were implanted, and in another a postinfarction ventricular septal rupture was closed.
Results: Before operation, 4 (50.0%) of the patients had congestive heart failure, 2 patients had unstable angina, and 2 were relatively asymptomatic. Six patients had ECG abnormalities (signs of myocardial infarction, persistent ST elevation). On chest x-ray 5 patients had cardiomegaly, and 2 of them had pulmonary edema. The definite diagnosis was established before operation in 7 patients and during the procedure in 1 patient. All patients survived operation, and none needed reoperation. An intraaortic balloon pump was used in 1 case. The postoperative courses of the other patients were uncomplicated. At the end of follow-up (mean, 31.0 ± 12.4 months) all patients were alive in New York Heart Association functional class I (6 patients) or II (2 patients).
Conclusion: The clinical presentation of chronic pseudoaneurysm often is nonspecific. The results of surgical treatment of chronic LV pseudoaneurysm are satisfactory.
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