Left ventricular aneurysm with 1- to 2-mm-thick myocardium: a variant of the classic true aneurysm?

From January 1983 to July 1985, 64 patients underwent left ventricular aneurysmectomy in our surgical unit. In 11 (17%) of these cases, the lesion was a variant of the true aneurysm that included an extremely thin (1- to 2-mm), well-defined area of myocardium. In 9 of the cases, the aneurysm was confirmed preoperatively by means of high-quality ventriculography (high resolution and many hues of gray). Surgical and pathologic criteria established the lesion's clinical significance. To the best of our knowledge, these aneurysms constitute a heretofore undescribed variant of the classic true left ventricular aneurysm, exhibiting certain gross characteristics of the false left ventricular aneurysm and sharing with false aneurysms their greater risk of rupture. While it is impossible to tell whether these aneurysms are progressing toward rupture, we believe that all such lesions should undergo urgent repair in the presence of cardiac symptoms. Following aneurysmectomy, ventriculoplasty or septoplasty using an elliptical woven Dacron patch helps to preserve the internal contour and surface anatomy of the ventricle. In our series, this procedure resulted in early and late postoperative mortality figures comparable to those associated with the surgical treatment of classic true left ventricular aneurysms.