Indications for Surgery : 95 per cent of ventricular aneurysms occur after transmural myocardial infarction. Trauma, Chaga's disease, sarcoidosis and congenital causes are the other aetiological factors. 85 per cent of then1 arc on the anterolateral wall of the LV, 5-10 per cent posterolatesally and less than 5 per cent are on the lateral wall. The clinical presentation may be with congestive cardiac failure, angina pectoris, ventricular arrhythmias, and dyspnoea or thrombo embolism. Rarely it could be asymptomatic. Diagilosis is confirmed by chest X-ray, ECG, ECHO and cardiac catheterization and LV and coronary angio. Special investigations like MRI. MUGA scan, thallium1 PET scan and electrophysiological study will be required in some cases before surgery.
In patients who have congestive heart failure, recurrent arrllythmias or thrombo embolism and when investigations show ventricular aneurysm, surgery is indicated. Other patients with angina and LV aneurysm will require surgery for aneurysm along with bypass grafts if coronary atigio shows significant blocks.
Patients with aneurysm and moderate mitral regurgitation also have to be advised surgery along with mitral valve repair.
A transmutable infarct is the pre requisite for the formulation of post infarction aneurysm. Total occlusion of LAD with poorly developed collaterals lead to extensive necrosis of muscle followed by thinning and aneurysm formation. The area becomes dyskinetic. The non-aneurysmal portion of the LV is subjected to increased systolic wall stress as ventricular size increases and ultimately loses its systolic reserve and contributes to LV failure. If there is multi vessel disease causing ischaenlia to the non-aneulysmal part of LV, the problem becomes worse.
Right venticular function could be impaired after extensive antero septa1 infarct because of dyskinesia of the ventricular septum.
Factors that determine survival are the size of aneurysm, severity and extent of coronary artery disease and the functional characteristics of the remainder of the LV wall.