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ORIGINAL ARTICLE

Left ventricular aneurysmectomy: late follow-up

José Luiz DanciniI; João Jorge RodriguesI; Jefferson dos SantosI; Rubens Fraga Alves PintoI; Fernando José da Costa BurgosI; Cesar Augusto ConfortiI

DOI: 10.1590/S0102-76381996000100006

ABSTRACT

Forty consecutive patients operated on between August 1987 and November 1994 were analysed, aiming at the late assessment of left ventricular aneurysmectomy in terms of symptomatology and global ventricular function. The follow-up ranged from 12 to 99 months. The most common location was anteromedial and most of the patients had both angina and CHF. The average preoperative LVEDP was 25.9 mmHg. Five patients (12.5%) died during hospitalization, due to acute myocardial failure, and 6 (15%) during the late postoperative period. When the series is divided into two groups, the survival rate among those operated on between 1991 and 1994 (the last 22 patients) is 91 % after 4 years. Of the 29 survivors, 12 (30%) are asymptomatic, while 42.5% have some degree of angina or CHF. Two-dimensional echocardiography showed normalization of the ventricular diameters, ejection fraction and percent fractional shortening in only 43% of the cases. After 1 year, only 50% of the patients are free of symptoms. The conclusion is that left ventricular aneurysmectomy caused symptomatic improvement in most of the patients, with an acceptable mortality rate, though nottotally confirmed by the indices of global function in two dimensional echocardiography.

RESUMO

Com o objetivo de avaliar tardiamente o efeito da aneurismectomia do ventrículo esquerdo quanto a sintomatologia e função ventricular global, foram analisados 40 pacientes consecutivos operados de agosto/87 a novembro/94, com um período de seguimento de 12 a 99 meses. A localização mais comum foi a ântero-medial e a maioria dos pacientes apresentava um quadro misto de angina e ICC. A pd2VE média preoperatoria foi de 25,9 mmHg. Cinco (12,5%) faleceram durante a internação, por insuficiência miocárdica aguda e 6 (15%), durante o pós-operatório tardio. Quando se divide a série em dois grupos, aqueles operados de 1991 a 1994 (últimos 22 pacientes) mostram uma sobrevida de 91% ao final de 4 anos. Dos 29 sobreviventes, 12 (30%) encontram-se assintomáticos, enquanto que 42,5% cursam com algum grau de angina ou ICC. O ecocardiograma bidimensional demonstrou normalização dos diâmetros ventriculares, das frações de ejeção e encurtamento em apenas 43% dos casos. Ao final de um ano, somente 50% dos pacientes estão livres de sintomas. Em conclusão, a aneurismectomia do ventrículo esquerdo promoveu melhora sintomática na maioria dos pacientes, com mortalidade aceitável, embora não totalmente confirmada pelos índices de função global ao ecocardiograma bidimensional.
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Article receive on Wednesday, January 31, 1996

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