Functional Imaging in Left Ventricular Aneurysm

Abstract

Prognosis in patients with true left ventricular aneurysms is seriously affected by common complications such as heart failure, severe dysrhythmias, and embolization of mural thrombi. Rupture of a true postinfarction aneurysm is quite rare, because of the strength of the fibrotic aneurysmal wall and the support of the thickened pericardium. There is general agreement that a complicated left ventricular aneurysm should have surgical correction since at this stage survival rate is higher with surgery than with medical treatment. Other proposed indicators for surgery are an LV end diastolic pressure over 20 mmHg, an increase of mean pulmonary pressure over 40 mmHG under mild stress, an LV end diastolic volume over 200ml/m² and a global ejection fraction below 30%, as well as a low rate of systolic shortening of still contractile segments. The risk of aneurysmectomy was noted to be inversely proportional to the ejection fraction of the still contractile section. Survival was reported to be 100% or 90% if this ejection fraction surpassed 45% or 39% respectively (Watson et al., 1975; Kapelanski et al., 1978). Surgical mortality is higher if a revascularization procedure has to be added to the aneurysmectomy (Burton et al, 1979).