Scand J Thor Cardiovasc Surg 26: 47-55, 1992
LEFT VENTRICULAR ANEURYSMECTOMY IN PATIENTS WITH POOR LEFT VENTRICULAR FUNCTION S. Oxelbark,' F. Mannting,2 M. G . Morgan2 and A. Henze'
Scand Cardiovasc J Downloaded from informahealthcare.com by QUT Queensland University of Tech on 11/06/14 For personal use only.
From the Departments of 'Cardiac Surgery and 2ClinicaiPhysiology (NuclearMedicine Section), University Hospital, Uppsala, Sweden (Accepted for publication November 11, 1991)
Abstract. Physical performance and left ventricular (LV) function in the resting state were assessed in 22 patients with postinfarction anterior-apical left ventricular aneurysm (LVA) and global ejection fraction < 20 YO who subsequently underwent radical LVA resection. The basic findings in the 20 survivors of surgery were significant improvement of global systolic LV function and more or less complete recovery of regional ejection fraction in the predominantly viable low and high lateral LV wall. This improvement was evident in patients with concomitant bypass grafting as well as in those with isolated and ungraftable lesions of the left anterior descending (LAD) coronary artery. We conclude that postinfarction anterior-apical LVA in a poorly functioning LV is suitable for surgical treatment, which can be accomplished with acceptable risk. All graftable stenotic major corolllLIy arteries should be bypassed, in addition to the LVA resection, but a minority of patients with isolated, ungraftable LAD disease are likely to benefit from aneurysmectomy alone. Key words: left ventricular aneurysm, left ventricular function, regional ejection fraction, myocardial revascularization.
reflect-at least in part-poor global LV ejection fraction, and most reports emphasize that congestive heart failure is the main reason for an unsatisfactory outcome of surgery. As in all types of surgery for ischemic heart disease, low global LV ejection fraction adversely affects the hospital mortality (14). Patients with seriously impaired ventricular function are sparsely represented in reports assessing the effects of LVA resection on postoperative recovery (5, 11, 24), and doubt has been expressed as to whether aneurysmectomy at all improves cardiac performance (2, 24). The following report concerns experience of LVA resection, with or without myocardial revascularization, in 22 patients with poor LV function, defined as global LV ejection fraction (LVEF) in the range 2-20 Oo/ at equilibrium radionuclide angiography. Interest was focused on global and regional ventricular recovery demonstrated at isotopic follow-up.
Cardiologists and surgeons acknowledge that symptomatic postinfarction left ventricular aneurysm (LvA) can be for treatmerit* The outcome Of LvA resection has been evaluated clinically, hemodynamically and with radionuclide technique (4-6, 13,21), and there is undoubtedly a degree of myocardial impairmerit beyond which the benefit Of is marginal. The breakpoint for successful operation has been defined in terms of observations
Patients. Our study comprised 22 patients with postinfarction LVA located in the anterior and apical portion of the LV, i.e. the territory of the left anterior descending coronary artery (LAD). Cardiac dysfunction was Pronounced, i-e. LVEF 109'0 indicates improvement. A decrease < 10% indicates deterioration. Changes within 5 10% are considered insignificant.
Clinical. The hospital mortality (
LEFT VENTRICULAR ANEURYSMECTOMY IN PATIENTS WITH POOR LEFT VENTRICULAR FUNCTION S. Oxelbark,' F. Mannting,2 M. G . Morgan2 and A. Henze'
Scand Cardiovasc J Downloaded from informahealthcare.com by QUT Queensland University of Tech on 11/06/14 For personal use only.
From the Departments of 'Cardiac Surgery and 2ClinicaiPhysiology (NuclearMedicine Section), University Hospital, Uppsala, Sweden (Accepted for publication November 11, 1991)
Abstract. Physical performance and left ventricular (LV) function in the resting state were assessed in 22 patients with postinfarction anterior-apical left ventricular aneurysm (LVA) and global ejection fraction < 20 YO who subsequently underwent radical LVA resection. The basic findings in the 20 survivors of surgery were significant improvement of global systolic LV function and more or less complete recovery of regional ejection fraction in the predominantly viable low and high lateral LV wall. This improvement was evident in patients with concomitant bypass grafting as well as in those with isolated and ungraftable lesions of the left anterior descending (LAD) coronary artery. We conclude that postinfarction anterior-apical LVA in a poorly functioning LV is suitable for surgical treatment, which can be accomplished with acceptable risk. All graftable stenotic major corolllLIy arteries should be bypassed, in addition to the LVA resection, but a minority of patients with isolated, ungraftable LAD disease are likely to benefit from aneurysmectomy alone. Key words: left ventricular aneurysm, left ventricular function, regional ejection fraction, myocardial revascularization.
reflect-at least in part-poor global LV ejection fraction, and most reports emphasize that congestive heart failure is the main reason for an unsatisfactory outcome of surgery. As in all types of surgery for ischemic heart disease, low global LV ejection fraction adversely affects the hospital mortality (14). Patients with seriously impaired ventricular function are sparsely represented in reports assessing the effects of LVA resection on postoperative recovery (5, 11, 24), and doubt has been expressed as to whether aneurysmectomy at all improves cardiac performance (2, 24). The following report concerns experience of LVA resection, with or without myocardial revascularization, in 22 patients with poor LV function, defined as global LV ejection fraction (LVEF) in the range 2-20 Oo/ at equilibrium radionuclide angiography. Interest was focused on global and regional ventricular recovery demonstrated at isotopic follow-up.
Cardiologists and surgeons acknowledge that symptomatic postinfarction left ventricular aneurysm (LvA) can be for treatmerit* The outcome Of LvA resection has been evaluated clinically, hemodynamically and with radionuclide technique (4-6, 13,21), and there is undoubtedly a degree of myocardial impairmerit beyond which the benefit Of is marginal. The breakpoint for successful operation has been defined in terms of observations
Patients. Our study comprised 22 patients with postinfarction LVA located in the anterior and apical portion of the LV, i.e. the territory of the left anterior descending coronary artery (LAD). Cardiac dysfunction was Pronounced, i-e. LVEF 109'0 indicates improvement. A decrease < 10% indicates deterioration. Changes within 5 10% are considered insignificant.
Clinical. The hospital mortality (
