[Emergency aneurysmectomy for persistent ventricular tachycardia]

Abstract

Aneurysms are a later consequence of acute myocardial infarction, developing in about 20% of patients with transmural infarcts. Pathologically aneurysms have two general forms: the first type has large endocardial fibroelastosis overlying the infarct size, the second type contains little or no endocardial fibroelastosis but often contains a large amount of mural thrombus. These pathologic types correlate with clinical complications. The first type is related to recurrent sustained ventricular arrhythmias, the second type to systemic embolism. The importance of endocardial pathology in pathogenesis of ventricular: arrhythmias is also suggested by recent endocardial stripping procedures. We report the case of a patient 63 years old, with ischemic left ventricular aneurysm complicated with multiple morphologic sustained ventricular tachycardia resistant to drug treatment. Standing hemodynamic shock and anginal symptoms, was performed left ventricular aneurysmectomy in state of emergency. The surgical treatment was successful. A programmed ventricular stimulation prior to hospital discharge, not induced ventricular tachycardia, also Holter monitoring was normal. The patient was discharged after 18 days. After 4 months he is well, and no arrhythmia was demonstrated during ambulatory controls.