Surgical Repair for Anterior and Inferior Ventricular Aneurysms

Objectives

Left ventricular aneurysm repair has been performed for nearly four decades, yet no surgical approach has been identified as the most effective. The authors describe their approach to repairing anterior and inferior aneurysms.

Methods

The surgical repair is illustrated in two patients, a 67-year-old woman and a 51-year-old man, with a beating and an arrested heart. For either type of aneurysm, the authors start by making an incision through the aneurysm and removing the mural thrombus (Figure 1A). Then they sew a Dacron patch into place and use a second layer of hemostatic suture that goes through double Teflon strips outside of the ventricle (Figure 1B). They add a third reinforcing suture layer over the entire repaired area (Figure 1C), which completes the repair (Figure 1D).

Results

The repair was hemostatic. Cardiac contractility was well preserved. Both patients were alive and well with normal cardiac function at 32 and 16 postoperative months, respectively.

Conclusion

This method of left ventricular aneurysm repair provided satisfactory results. It appears to be a good technique for repair of both anterior and inferior wall aneurysms, having no short- or mid-term complications.

Additional Resources

  1. Henry MJ, Preventza O, Cooley DA, de la Cruz KI, Coselli JS. Left ventricular aneurysm repair with use of a bovine pericardial patch. Tex Heart Inst J. 2014;41(4):407-410.
  2. Reddy SB, Cooley DA, Duncan JM, Norman JC. Left ventricular aneurysm: twenty-year surgical experience with 1572 patients at the Texas Heart Institute. Cardiovasc Dis. 1981;8(2):165-186.
  3. Shapira OM. Left ventricular aneurysm and pseudoaneurysm following acute myocardial infarction. In: UpToDate. Gersh BJ, Saperia GM, eds. https://www.uptodate.com/contents/left-ventricular-aneurysm-and-pseudoaneurysm-following-acute-myocardial-infarction. Accessed May 25, 2018.

This work was presented at the ECTSS 56th Annual Meeting in Clearwater Beach, Florida, Oct 17 - 20, 2018.