Left ventricular aneurysm natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Heart failure, ventricular arrhythmia, mural thrombosis, and ventricular rupture, are complications of LV aneurysm that may develop despite proper treatment of the underlying myocardial event. The overall prognosis is dependent on the size of the aneurysm, the presence of akinesia, and the extent of the underlying cardiac event.

Natural History

If left untreated, it may lead to heart failure and persistent anginal pain. For false aneurysms, rupture and hemodynamic compromise are the usual outcomes if left untreated. Improvements in STEMI management, control of hypertension, and avoidance of corticosteroids in STEMI have led to a better prognosis and decreased mortality.^[1]

Complications

Mural thrombi

It occurs in almost 50% of patients and can be detected by angiography or echocardiography.^[1]

Heart failure

Paradoxical movement in the aneurysmal portion of the LV wall reduces the efficiency of the ventricular contraction, and compromises the stroke volume. It may lead to LV dilation and an increase in LV end-diastolic pressure, this may be accompanied by chest pain.^[2]^[3]

Arrhythmia

Approximately 15% have symptomatic ventricular arrhythmias that may be intractable and life-threatening.^[4]

Ventricular rupture

Unlike false aneurysms, a mature true LV aneurysm rarely ruptures.^[5]

Prognosis

Depending on the size of the aneurysm, the extent of the underlying cardiac event, the presence of complications, and the promptness of medical intervention, the prognosis may vary. However, the overall prognosis is improved by modern treatment and advanced management.

References

↑ ^1.0 ^1.1 Mourdjinis A, Olsen E, Raphael MJ, Mounsey JP (1968). “Clinical diagnosis and prognosis of ventricular aneurysm”. Br Heart J. 30 (4): 497–513. PMC 487659. PMID 5659397.
↑ Nicolosi AC, Spotnitz HM (1988). “Quantitative analysis of regional systolic function with left ventricular aneurysm”. Circulation. 78 (4): 856–62. PMID 3168193.
↑ Klein MD, Herman MV, Gorlin R (1967). “A hemodynamic study of left ventricular aneurysm”. Circulation. 35 (4): 614–30. PMID 6024006.
↑ Waldo AL, Arciniegas JG, Klein H (1981). “Surgical treatment of life-threatening ventricular arrhythmias: the role of intraoperative mapping and consideration of the presently available surgical techniques”. Prog Cardiovasc Dis. 23 (4): 247–64. PMID 7008078.
↑ Vlodaver Z, Coe JI, Edwards JE (1975). “True and false left ventricular aneurysms. Propensity for the altter to rupture”. Circulation. 51 (3): 567–72. PMID 1132088.

Template:WikiDoc Sources

[pmid5659397-1] 1.0 ^1.1 Mourdjinis A, Olsen E, Raphael MJ, Mounsey JP (1968). “Clinical diagnosis and prognosis of ventricular aneurysm”. Br Heart J. 30 (4): 497–513. PMC 487659. PMID 5659397.

[pmid3168193-2] Nicolosi AC, Spotnitz HM (1988). “Quantitative analysis of regional systolic function with left ventricular aneurysm”. Circulation. 78 (4): 856–62. PMID 3168193.

[pmid6024006-3] Klein MD, Herman MV, Gorlin R (1967). “A hemodynamic study of left ventricular aneurysm”. Circulation. 35 (4): 614–30. PMID 6024006.

[pmid7008078-4] Waldo AL, Arciniegas JG, Klein H (1981). “Surgical treatment of life-threatening ventricular arrhythmias: the role of intraoperative mapping and consideration of the presently available surgical techniques”. Prog Cardiovasc Dis. 23 (4): 247–64. PMID 7008078.

[pmid1132088-5] Vlodaver Z, Coe JI, Edwards JE (1975). “True and false left ventricular aneurysms. Propensity for the altter to rupture”. Circulation. 51 (3): 567–72. PMID 1132088.

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