SURGICAL MANAGEMENT OF LEFT VENTRICULAR ANEURYSM AS A COMPLICATION OF ACUTE MYOCARDIAL INFARCTION - A SINGLE SURGEON EXPERIENCE

Abstract

Left ventricular aneurysm is a localized area of the myocardium, with abnormal outward bulging and deformation during systole and diastole, which may be an akinetic, dyskinetic hypokinetic segment. It is due to the weakening of the muscle wall. The aim of this study is the assessment of the Left Ventricular aneurysm, its clinical presentation, Repair technique, and surgical outcome of patients presented with Acute Myocardial infarction with Ventricular wall complications. A retrospective study of the case scenarios that have undergone LV aneurysm repair in a tertiary care hospital facility over four years (2015-2019) after being diagnosed with Acute and evolved Myocardial infarction, which has been rehabilitated by medical management and then referred from cardiology. The Cases with aneurysm were diagnosed by 2d- echocardiography, examined for window period, taken up for surgery, which is re-vascularisation and surgical ventricular remodeling. Of the 6 cases operated, the results were as follows. The mean age of presentation is early for patients with co-morbidities like diabetes and hypertension. Female preponderance is seen. Habitual alcohol consumption causes an early presentation of symptoms. Severe LV dysfunction due to occlusion of the Left coronary artery causes this aneurysm. The most frequent site of aneurysm is the anterior wall with an apex. Apex or Distal anterior wall involvement is repaired by Dor or Linear repair. A septal aneurysm is repaired by septal exclusion by linear Dacron. To conclude, acute MI due to Single or Triple vessel disease can lead to LV aneurysm, which can be Akinetic or Dyskinetic segment.LV Aneurysm as a complication can have a varied presentation, including an Anterior wall, Apex, Apex, and variable extent of the septum and posterior wall, with varied ventricular function with organic valvular MR or Functional MR. Patients with Hypertension and Habitual alcohol consumption have an early age of presentation