Clinical improvement after ventricular aneurysm repair: prediction by angiographic and hemodynamic variables.
Surgical repair of a left ventricular aneurysm is associated with significant perioperative mortality and substantial mortality in the first 2 years after operation. In a retrospective review of 42 patients undergoing repair of an anteroapical aneurysm, two cardiac catheterization variables were identified that predicted a good surgical outcome, defined as perioperative survival and improved functional status. Specifically, patients with an ejection fraction of the contractile section (nonaneurysmal) of the left ventricle of 35% or greater and a left ventricular end-diastolic pressure of 25 mm Hg or less had a low perioperative mortality rate (6.5%), experienced no late mortality and had sustained clinical improvement of at least one New York Heart Association functional class (93.5%). In contrast, patients with a contractile section ejection fraction of less than 35% or a left ventricular end-diastolic pressure greater than 25 mm Hg had a higher perioperative mortality rate (27.3%), experienced a substantial late mortality rate (27.3%) or had no significant functional class improvement (9%); only 36.4% had sustained clinical improvement. This study suggests that the postoperative results of left ventricular aneurysm repair are dependent on the hemodynamic status of the nonresected left ventricle.
D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000503:physiopathology; D006328:Cardiac Catheterization; D003327:Coronary Disease / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology; D003971:Diastole; D005260:Female; D006322:Heart Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D011859:Radiography; D013318:Stroke Volume