Left ventricular scars. Clinical and haemodynamic results of excision.

Abstract

Thirty-six patients having coronary artery disease with scars occupying at least io per cent of the left ven- tricular internal surface area were followed from one to three and a halfyears after excision of the scar with or without a revascularization procedure. The operative mortality was I9-4 per cent and the late mortality was 30-6 per cent. Of the survivors, i.5 patients (4I 7% of the total group ofpatients) are improved by opera- tion and 3 (8.3%) are unchanged or worse. All patients, regardless of whether their principal complaints were dyspnoea or angina, showed evidence before surgery of left ventricular dysfunction. No haemodynamic meas- urement was of value in predicting the results of surgery. The presence of moderately severe mitral regurgita- tion was associated with a poor prognosis. Patients improving after operation tended to have severe occlusive disease in no more than I vessel, while patients who failed to improve tended to have severe occlusive disease in 2 or more vessels. Nevertheless, the overlap was great enough that no reliable prognostic indices can be said to exist at present. Approximately 4 tO 20 per cent of patients who have had a myocardial infarction will develop a thin- walled scar which can be classified at necropsy as an aneurysm (Abrams et al., I963; Johnston, Lam, and Wright, I969; Dubnow, Burchell, and Titus, I965; Schlichter, Hellerstein, and Katz, I954). The in- cidence of akinetic and dyskinetic scars detected angiographically in patients with healed myocardial infarctions is somewhat higher (Gorlin, Klein, and Sullivan, I967; Cheng, 1971). Symptoms, when present in patients with large scars of the left ventricle, are predominantly angina pectoris and