title: Surgical treatment of postinfarction left ventricular pseudoaneurysms.
abstract: OBJECTIVE
  Left ventricular pseudoaneurysm is a rare but serious complication of acute myocardial infarction. It is under debate whether surgical intervention is mandatory in asymptomatic patients. The aim of this report was to present our experience based on surgical treatment and midterm outcomes of patients with postinfarction left ventricular pseudoaneurysm.
  
  
  METHODS
  Eight consecutive patients who underwent left ventricular pseudoaneurysm operation between January 1, 1995, and January 1, 2006, were included in the study. There were 5 male and 3 female patients. Mean age was 62.87 +/- 5.03 years. All patients had echocardiography and coronary angiography before the operation. Two anterior and 6 posterior pseudoaneurysms were detected. Left ventricular pseudoaneurysm was repaired with a synthetic patch by the remodeling ventriculoplasty method of Dor in all patients. Coronary revascularization was performed if necessary. Preoperative, operative, and postoperative data were collected from the patient cohorts.
  
  
  RESULTS
  The mean duration from myocardial infarction to diagnosis of the ventricular septal rupture was 13.5 +/- 12 days. Additional coronary artery bypass surgery was performed with a median of 1.2 grafts in 5 patients (62.5%). The mean postoperative mechanic ventilator support time was 20.12 +/- 29.22 hours. Overall 30-day mortality was 12.5% with 1 patient death. The mean intensive care unit stay was 3.75 +/- 2.1 days. The late mortality rate was 12.5%. In the follow-up period (mean, 30.66 +/- 16.86 months), of the 6 patients who were alive, 5 were in New York Heart Association class I or II and 1 was in class III because of pre-existing low left ventricular ejection fraction. Transthoracic echocardiography showed good left ventricular configurations without a false aneurysm together with increases in the ejection fractions.
  
  
  CONCLUSIONS
  Prompt diagnosis and early surgical intervention is essential for patients with large or expanding left ventricular pseudoaneurysms due to the high propensity of fatal rupture. Associated coronary artery bypass grafting may reduce early mortality of patients with left ventricular pseudoaneurysm by resuscitating the ischemic myocardium.
authors.affiliation: Department of Cardiovascular Surgery, Izmir Ataturk Training and Research Hospital, Izmir, Turkey.
authors.forename: Banu
authors.initials: B
authors.lastname: Lafci
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Ozsöyler
authors.forename: Bilgin
authors.initials: B
authors.lastname: Emrecan
authors.forename: Tayfun
authors.initials: T
authors.lastname: Göktogan
authors.forename: Sahin
authors.initials: S
authors.lastname: Bozok
authors.forename: Haydar
authors.initials: H
authors.lastname: Yasa
authors.forename: Nagihan
authors.initials: N
authors.lastname: Karahan
authors.forename: Ali
authors.initials: A
authors.lastname: Gürbüz
mesh_terms: D017541:Aneurysm, False / Q000150:complications* / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000601:surgery*