Management of Left Ventricular Aneurysm: A Study from Iraq

Abdulsalam Y. Taha, Bassam A. Mahmoud

Department of Cardiac Surgery, Ibn-Albitar Center for Cardiac Surgery (IBCCS), Baghdad, Iraq.
Department of Thoracic and Cardiovascular Surgery, School of Medicine and Sulaimania Teaching Hospital, Sulaimania, Iraq.

DOI: 10.4236/ijcm.2014.54021                

Abstract

Background: The most appropriate surgical approach for post-myocardial infarction left ventricular aneurysm (LVA) is controversial. This study aims to display the results of surgical treatment of LVA in a major Iraqi cardiac surgical center. Methods: The surgical management of LVAs over the period 2001 to 2011 was retrospectively reviewed. The presenting signs and symptoms, results of investigations, operative findings, and outcomes of patients were determined. Results: Twenty-seven true LVAs associated with 4 ventricular septal defects (VSDs) were treated surgically. During the same period, 1136 coronary artery bypass graft (CABG) operations were done, thus LVA represented 2.4%. Males constituted the majority (74.1%). The mean age was 54.6 years old. The typical ECG changes were seen in 42.1%. Apical and antero-apical locations predominated. The majority of patients (84.2%) had subnormal values of ejection fraction (EF). Most patients had multi-vessel coronary artery disease (CAD). The most frequent was the left anterior descending artery (LAD). All patients had CABG except 3. Linear repair and Dor technique were used equally. The commonest postoperative complication was bleeding (38.4%). The overall hospital mortality was 18.5%. Conclusion: Concomitant CABG improves early postoperative course and must be added when significant lesions in coronary arteries particularly the LAD are present.

Keywords

Left Ventricular Aneurysm; Post-Ischemic VSD; Linear Repair and Dor Technique

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	G. D. Di and L. J Ei, “Left Ventricular Aneurysm,” In: L. H. Cohn and L. H. Edmunds Jr., Eds., Cardiac Surgery in the Adult, McGraw-Hill, New York, 2003, pp. 771-788.
[2]	M. Mukaddirov, R. G. Demaria, L. P. Perrault, J.-M. Fradier and B. Albat, “Reconstructive Surgery of Post Infarction Left Ventricular Aneurysms: Techniques and Unsolved Problems,” European Journal of Cardio-Thoracic Surgery, Vol. 34, No. 2, 2008, pp. 256-261. http://dx.doi.org/10.1016/j.ejcts.2008.03.061
[3]	M. Mukkadirov, J.-M. Frapier, R. G. Demaria and B. Albat, “Surgical Treatment of Post Infarction Left Ventricular Aneurysms: Linear vs. Patch Plasty Repair,” Interactive Cardiovascular and Thoracic Surgery, Vol. 7, No. 2, 2008, pp. 256-261. http://dx.doi.org/10.1510/icvts.2007.160093
[4]	P. E. Antunes, R. Silva, J. F. de Oliveira and M. J. Antunes, “Left Ventricular Aneurysms: Early and Late Long-Term Results of Two Types of Repair,” European Journal of Cardio-Thoracic Surgery, Vol. 27, No. 2, 2005, pp. 210-215. http://dx.doi.org/10.1016/j.ejcts.2004.11.010
[5]	L. Menicanti and M. Di Donato, “Left Ventricular Aneurysm/Reshaping Techniques,” MMCTS, Vol. 2005, No. 0425, 2005. http://dx.doi.org/10.1510/mmcts.2004.000596
[6]	E. Stahle, R. Bergestrom, S. O. Nystrom, B. Edlund, I. Sjorgren and L. Holmberg, “Surgical Treatment of Left Ventricular Aneurysm-Assessment of Risk Factors for Early and Late Mortality,” European Journal of Cardio-Thoracic Surgery, Vol. 8, No. 2, 1994, pp. 67-73. http://dx.doi.org/10.1016/1010-7940(94)90094-9
[7]	Ed Burns, ECG Library, Life in the fastlane.com.
[8]	J. Edhouse, et al., “ABC of Clinical Electrocardiography,” BMJ, Vol. 324, No. 20, 2002, pp. 963-969. www.bmj.com
[9]	W. J. Brady, R. A. Harrigan and T. Chan, “Diagnosis: Left Ventricular Aneurysm,” Cases in Electrocardiography. Emergency Medicine News, Vol. 28, No. 6, 2006, p 38. http://dx.doi.org/10.1097/00132981-200606000-00025
[10]	V. N. Singh and J. A. Strom, “Ventricular Aneurysm Imaging,” 2012.
[11]	K. M. Vural, E. Sener, M. A. Ozatic, O. Tasdemir and K. Bayazit, “Left Ventricular Aneurysm Repair: An Assessment of Surgical Treatment Modalities,” European Journal of Cardio-Thoracic Surgery, Vol. 13, No. 1, 1998, pp. 49-56. http://dx.doi.org/10.1016/S1010-7940(97)00287-X
[12]	L. E. Watson, D. W. Dickhaus and R. H. Martin, “Left Ventricular Aneurysm: Preoperative Haemodynamics, Chamber Volume and Results of Aneurysmectomy,” Circulation, Vol. 52, No. 5, 1975, pp. 868-873. http://dx.doi.org/10.1161/01.CIR.52.5.868
[13]	A. Mangschau, S. Simonsen, M. Abdelnoor, B. Laake and O. Geiran, “Evaluation of Left Ventricular Aneurysm Resection: A Prospective Study of Clinical and Haemodynamic Characteristics,” European Journal of CardioThoracic Surgery, Vol. 3, No. 1, 1989, pp. 58-64. http://dx.doi.org/10.1016/1010-7940(89)90013-4
[14]	R. Lundblad, M. Abdelnoor and J. L. Svennevig, “Repair of Left Ventricular Aneurysm: Surgical Risk and Long-Term Survival,” The Annals of Thoracic Surgery, Vol. 76, No. 3, 2003, pp. 719-725. http://dx.doi.org/10.1016/S0003-4975(03)00677-5
[15]	A. V. Marchenko, A. M. Cherniavsky, T. L. Volokitina, A. S. Alsov and A. M. Karaskov, “Left Ventricular Dimension and Shape after Postinfarction Aneurysm Repair,” European Journal of Cardio-Thoracic Surgery, Vol. 27, No. 3, 2005, pp. 475-480. http://dx.doi.org/10.1016/j.ejcts.2004.12.025
[16]	O. Shindler, A. Spotnitz and D. Shindler, “Aneurysm and Ventricular Septal Defect Following Myocardial Infarction,” E-Chocardiography Journal, 1995. http://rwjms1.umdnj.edu/Shindler/vsdaneurysm.html
[17]	A. D. Heath, A. M. Harris and M. P. Wright, “Clinical Features and Repair of Ventricular Septal Defect and Left Ventricular Aneurysm Complicating Myocardial Infarction,” British Heart Journal, Vol. 32, No. 6, 1970, pp. 863-866. http://dx.doi.org/10.1136/hrt.32.6.863
[18]	G. Lazopoulos, M. Manns-Kantartzis and M. Kantartzis, “Giant Left Ventricular Aneurysm and Intra-Ventricular Septal Defect after Silent Myocardial Infarction,” The Hellenic Journal of Cardiology, Vol. 50, 2009, pp. 142-143.
[19]	A. S. Olearchyk, G. M. Lemole and P. M. Spagna, “Left Ventricular Aneurysm. Ten Years Experience in Surgical Treatment of 244 Cases. Improved Clinical Status, Hemodynamics and Long-Term Longevity,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 88, No. 4, 1984, pp. 544-553.
[20]	H. E. Eid, “Role of Intra-Aortic Balloon Pump in Left Ventricular Endoaneurysmorrhaphy,” Asian Cardiovascular and Thoracic Annals, Vol. 7, No. 4, 1999, pp. 276-281. http://dx.doi.org/10.1177/021849239900700406