Evaluation of Left Ventricular Apical Aneurysms by Cross Sectional Echocardiography

Abstract

Shape and contraction pattern of the left ventricular apex were examined in 25 consecutive patients with angiographically demonstrated apical aneurysms and 15 normal subjects using a real-time high resolution mechanical sector scanner. Examinations were conducted with the probe placed directly over the left ventricular apex with the sweep of the scan parallel to the long axis of the left ventricle. In normal patients the anterior and posterior walls of the left ventricle tapered to a rounded tip. At the onset of systole the apical segment showed initial motion toward the base of the heart followed by an inward motion of the anterior and posterior wall. When endocardium and epicardium were recorded, systolic thickening of the walls of the apical segment was also observed. In patients with apical aneurysms the normal tapering of the ventricular apex was lost and the apex became rounded and dilated. In addition normal contraction toward the base of the heart was either absent or motion of the apical segment was in a direction opposite to the base of the heart. Recognition of apical aneurysms was facilitated by the observation of a hinge point seperating normal muscular contraction from the akinetic or dyskinetic segment. This hinge point was most frequently observed along the inferior surface of the heart. In addition to changes in contraction pattern, no endocardium could be recorded in the area of the ventricular aneurysm.