V. Greere 1, I.I. Bruckner 2, Mariana Greere 3, G. Cristian 4, Mariana Jinga 5, V. Goleanu 6, M. Gafencu 7, I. Ţintoiu 8
1 Medic primar cardiolog, doctorand, Centrul de Boli Cardiovasculare al Armatei (CBCVA)
2 Profesor doctor , Clinica de Medicină internă, Spitalul Clinic Colţea
3 Medic primar ATI, doctorand, Secţia ATI, Spitalul Clinic Colţea
4 Medic primar cardiolog, doctorand, Centrul de Boli Cardiovasculare al Armatei (CBCVA)
5 Medic primar cardiolog, doctorand, Centrul de Boli Cardiovasculare al Armatei (CBCVA)
6 Medic primar chirurg — chirurgie cardiovasczdară, doctorand, Centrul de Boli Cardiovasculare al Armatei (CBCVA)
7 Medic primar chirurg — chirurgie cardiovasculară, doctor în medicină, Centrul de Boli Cardiovasculare al Armatei (CBCVA)
8 Conferenţiar doctor, medic primar medicină internă şi cardiologie, Centrul de Boli Cardiovasculare al Armatei (CBCVA)
Abstract
The left vetricular aneurysm after myocardial infarction represents a late complication witch needs a very accurate morphological and functional diagnosis followed by a complex medical and surgical treatment. The medical therapy is adressed to morphological cause and to main disease (coronary heart disease due to coronary atherosclerosis) and to the complications of the aneurysm (congestive heart failure, thrombosis and systemic embolization, arrhythmias). This has a limited eficacy. Therefore, the patients are directed to the cardiac surgeon after a very accurate noninvazive and invazive evaluation before surgery (left ventriculography, coronarography). The indications for surgery are the congestive cardiac failure, the angina, the arrhythmias, mitral regurgitation associated with aneurysm. The surgical technics are adressed to aneurysm itself (linear closure; inverted “T” closure, endoventricular patch plasty) to coronary arteries (CABG with left internal mamary artery or vein), to mitral valve (angyloplasty, conservative surgery, mitral valve replacement) or cardiac transplant. The tendency is to give up to resection and linear suture and to chose the new technics of reconstruction for reestablishment of the initial ventricular shape. The operative mortality is 8 – 10%. The complications after surgery and the surgical results are debated.