[Surgical treatment of postinfarctual left ventricular aneurysm (author's transl)].

: Ventricular aneurysm is a frequent complication of myocardial infarction, but its diagnostic and prognostic implications are not fully defined. A surgical series of 66 ventricular resections for symptomatic left ventricular aneurysm is analyzed. Pts. age varied between 26-29 years; the interval between the episode of infarction and operation from 2 mos. to 12 years. Indication for surgery was angina in 53% of the cases, heart failure in 23%, arrhythmias in 15%, angina and failure in 9%. In 55 cases surgical findings were consistent with true aneurysm in the anatomical sense, in 11 cases with a wide area of wall akinesia. In 24 cases endocavitary thrombosis was present. In 23 cases aneurysmectomy was the only surgical procedure, with closure of acquired VSD in 1 case and mitral valve prosthesis in 2 cases. In 43 cases aorto-coronary bypass grafting was associated (single bypass in 18, double in 23, triple in 2). Operative technique underwent modifications in time, in relation to the use of local and general hypothermia, of cardioplegia, of early aortic cross-clamping. Surgical mortality was of 7.5% (5 cases); the actuarial courve, including operative mortality, showed survival of 88% at 1 year and of 78% at 5 years interval. Correlation between mortality and clinical symptomatology, hemodynamic data and surgical findings was not statistically significant; a statistically highly significant correlation was found between mortality and operative technique. The results are interpreted and discussed in relation to the diagnostic definition of the problem, to the criteria of indication to surgery and to the operative technique.