Chapter 30

Left ventricular aneurysm has been strictly defined as a distinct area of abnormal left ventricular diastolic contour with systolic dyskinesia or paradoxical bulging (Fig. 30-1).1,2 Yet, a growing number of authors favor defining left ventricular aneurysm more loosely as any large area of left ventricular akinesia or dyskinesia that reduces left ventricular ejection fraction.3–5 This broader definition has been justified by data suggesting that the pathophysiology and treatment may be the same for ventricular akinesia and for ventricular dyskinesia.4,6 However, recent studies suggest that the optimal treatment and outcomes of patients with akinetic segments versus dyskinetic segments might be different.7,8 Intraoperatively, a left ventricular aneurysm may also be identified as an area that collapses upon left ventricular decompression.3,6,9 True left ventricular aneurysms involve bulging of the full thickness of the left ventricular wall, whereas a false aneurysm of the left ventricle is, in fact, a rupture of the left ventricular wall contained by surrounding pericardium.

###### Figure 30-1

Diagrammatic distinction between aneurysm and other states of the left ventricle. (Reproduced with permission from Grondin P, Kretz JG, Bical O, et al: Natural history of saccular aneurysm of the left ventricle. J Thorac Cardiovasc Surg 1979; 77:57.)

Left ventricular aneurysms have long been described at autopsy, but left ventricular aneurysm was not recognized to be a consequence of coronary artery disease until 1881.10 The angiographic diagnosis of left ventricular aneurysm was first made in 1951.10 A congenital left ventricular aneurysm was first treated surgically by Weitland in 1912 using aneurysm ligation. In 1944, Beck11 described fasciae latae plication to treat left ventricular aneurysms. Likoff and Bailey12 successfully resected a left ventricular aneurysm through a thoracotomy in 1955 using a special clamp without cardiopulmonary bypass. The modern treatment era began in 1958 when Cooley et al.13 successfully performed a linear repair of a left ventricular aneurysm using cardiopulmonary bypass. More geometric ventricular reconstruction or restoration techniques were subsequently devised by Stoney et al.,14 Daggett et al.,15 Dor et al.,16 Jatene,17 and Cooley et al.18,19

The incidence of left ventricular aneurysm in patients suffering from myocardial infarction has varied between 10 and 35% depending on the definition and the methods used. Of patients undergoing cardiac catheterization in the CASS study, 7.6% had angiographic evidence of left ventricular aneurysms.20 The absolute incidence of left ventricular aneurysms may be declining because of the increased use of thrombolytics and revascularization after myocardial infarction.21,22

More than 95% of true left ventricular aneurysms reported in the English literature result from coronary artery disease and myocardial infarction. True left ventricular aneurysms also may result from trauma,23 Chagas' disease,24 or sarcoidosis.25 A very small number ...

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