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 (26 degrees C-28 degrees C). 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.