Ravikrishnan J, Arun N, Anish M. Varkey
OBJECTIVES: This is a long term follow up of 54 patients with post infarct left ventricular aneurysm, operated over a period of 5 years, from 2005 to 2010, in a rural cardiac centre. This study aims at assessing efficacy of simple linear closure technique and its long term results. Follow up was done over a period of 2 to 5 years by clinical examination and 2D echocardiography. MATERIALS AND METHODS: 54 patients underwent surgery for left ventricular aneurysm. Age ranged from 50 – 70 years. 50 patients were operated electively and 4 patients within 15 days of acute myocardial infarction. All were approached by median sternotomy incision. Aortic canulation was done after heparinisation (3mg/kg). Aorto-bicaval canulation was employed and membrane oxygenators were used in all patients. After cross clamping the aorta, blood cardioplegia was used in all patients. Aortic cross clamp time varied from 40-90 min and bypass time varied from 90-120 min. Aneurysm was resected and sutured with 2/0 prolene and Teflon felt reinforcement with CABG as concomitant procedure in some. Inotropic support with adrenaline, dopamine or dobutamine was used in all patients. IABP was employed in 48 patients. All patients were electively ventilated for 24-48 hours. 6 required re exploration due to bleeding. 10 patients had mild MR which was left alone. RESULTS: 54 patients were operated for left ventricular aneurysm over a period of 5 years. 4 patients died postoperatively due to low cardiac output and arrhythmias. Follow up was done clinically and with 2D Echocardiography. At the end of 2 years, 22 patients showed no further improvement in LVEF, 32 patients LVEF improved by 10-15%. All patients required decongestive management. 6 patients died at the end of 2 years. CONCLUSION: Timely and planned surgery with simple techniques, for left ventricular aneurysms can give acceptable mortality and morbidity, in a rural cardiac Centre
