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Ventricular aneurysm — Clinical Guidelines

Overview

Ventricular aneurysm refers to a localized dilation or bulge in the ventricular wall, often resulting from myocardial infarction, characterized by impaired contractility and potential complications such as rupture or hemodynamic instability. 1 2 7

Diagnosis

Clinical Presentation: Often associated with signs of heart failure and abnormal cardiac contours.

Imaging Techniques:

- Thallium-201 Scintigraphy: Detects perfusion defects indicative of ventricular aneurysm. 5 - Echocardiography: Useful for visualizing residual myocardium and assessing ventricular dimensions; M-mode echocardiography can predict surgical outcomes. 7 10 - Contrast Ventriculography: Gold standard for definitive diagnosis. 5

Distinguishing True from False Aneurysm: Important for management; false aneurysms are prone to rupture and may present with specific murmurs. 8

Management

Surgical Repair:

- Ventriculoplasty: Involves resection of the aneurysm and closure with autologous pericardium or resorbable sutures (e.g., PDS) to prevent complications like bleeding and infection. 3 4

Adjunctive Therapies:

- Medical Management: Includes treatment of heart failure symptoms with diuretics, ACE inhibitors, beta-blockers, and other supportive care measures. 7

Special Populations

Elderly: Higher risk of postoperative complications; careful preoperative assessment and tailored surgical approaches are crucial. 6

Comorbidities: Presence of comorbidities like severe heart failure impacts surgical outcomes and necessitates individualized treatment plans. 6 9

Key Recommendations

Utilize echocardiography, particularly cross-sectional and M-mode techniques, to assess ventricular function and predict surgical outcomes before aneurysmectomy (Evidence: Moderate) 7 10

Employ autologous pericardium or resorbable sutures (e.g., PDS) for closure post-aneurysmectomy to minimize infection risk and improve hemostasis (Evidence: Moderate) 3 4

Consider the distinction between true and false aneurysms for appropriate management strategies, given the higher risk of rupture in false aneurysms (Evidence: Expert opinion) 8

References

1 Gu J, McGrath LB. Localized endocrine conversion of ventricular cardiocytes in ventricular aneurysm. The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society 1990. link 2 Harding SE, Vescovo G, Jones SM, Bennett G, Yacoub M, Poole-Wilson PA. Morphological and functional characteristics of myocytes isolated from human left ventricular aneurysms. The Journal of pathology 1989. link 3 Fiore AC, McKeown PP, Misbach GA, Allen MD, Ivey TD. The use of autologous pericardium for ventricular aneurysm closure. The Annals of thoracic surgery 1988. link64540-7) 4 Vincent JG, Skotnicki SH, van der Meer JJ, Kubat K. Resorbable suture support for ventricular aneurysmectomy. The Journal of thoracic and cardiovascular surgery 1987. link 5 Weizenberg A, Goodenday LS, Leighton RF. Scintigraphic detection of ventricular aneurysm with thallium-201. Journal of nuclear medicine : official publication, Society of Nuclear Medicine 1983. link 6 Crosby IK, Wellons HA, Martin RP, Schuch D, Muller WH. Employability--a new indication for aneurysmectomy and coronary revascularization. Circulation 1980. link 7 Barrett MJ, Charuzi Y, Corday E. Ventricular aneurysm: cross-sectional echocardiographic approach. The American journal of cardiology 1980. link90283-0) 8 Malcolm ID, Fitchett DH, Stewart D, Marpole D, Symes J. Ventricular aneurysm: false or True? An important distinction. The Annals of thoracic surgery 1980. link61683-9) 9 Hutchins GM, Brawley RK. The influence of cardiac geometry on the results of ventricular aneurysm repair. The American journal of pathology 1980. link 10 Dillon JC, Feigenbaum H, Weyman AE, Corya BC, Peskoe S, Chang S. M-mode echocardiography in the evaluation of patients for aneurysmectomy. Circulation 1976. link

Ventricular aneurysm