Submitral left ventricular aneurysms. Correction by a new transatrial approach.

Submitral left ventricular aneurysm is a widely recognized but relatively unknown entity that occurs almost exclusively in African patients and is often associated with mitral regurgitation. In the past 2 1/2 years, nine patients with submitral aneurysm were operated on by a new transatrial approach that exposes the neck of the aneurysm through an incision in the floor of the left atrium (roof of the aneurysm). There were four female and five male patients and the mean age was 28 +/- 3 years (range 23 to 35 years). All patients but one had significant mitral valve regurgitation and were in New York Heart Association Class III or IV. All operations were performed with standard cardiopulmonary bypass. At operation the neck of the aneurysm was invariably found beneath the posterior mitral valve anulus, at any site between the anterolateral and posteromedial commissures. The transverse diameter was variable, replacing up to two thirds of this portion of the annulus. In one patient the aneurysm perforated into the left atrial cavity. The neck of the aneurysm was closed directly in all patients and all mitral valves were preserved. Comprehensive valvuloplasty, including a Carpentier ring, was required in four patients. One patient died on the operating table of an uncontrolled diffuse pericardial hemorrhage. The remainder were discharged from the hospital and have good mitral valve function postoperatively. The transatrial approach to the repair of submitral left ventricular aneurysms results in a lower operative mortality and morbidity and almost invariably permits conservation of the mitral valve.