Left ventricular aneurysm, intraaneurysmal thrombus and systemic embolus in coronary heart disease.

left ventricular aneurysm has been reported in association with noncoronary types of cardiac disease, such as hypertrophic cardiomyopathy,’ congenital deficiencies of myocardium,2 sarcoidosis,3 and postoperatively after mitral valve replacement,4 most occur as a consequence of severe coronary narrowing with myocardial infarction. Most reports on surgical and/or necropsy patients with coronary-induced left ventricular myocardial infarcts and aneurysms have demonstrated a high frequency of thrombi within the aneurysms. Intraaneurysmal thrombi were present in 155 (49 percent) of 314 necropsy patients (from five different studies) 9 and in 411 (47 percent) of 867 surgical patients who underwent left ventricular aneurysmectomy (from ten different studies). 10-19 In contrast to the relative uniform reporting of a high frequency of thrombi within left ventricular aneurysms, the reported frequency of systemic emboli in patients with left ventricular aneurysms has varied considerably. Systemic emboli were described in 100 (32 percent) of the 314 patients with left ventricular aneurysms documented at necropsy, #{176} but in only 59 (5 percent) of 1,180 reported patients in whom aneurysms were diagnosed by angiography and/or operation.” 6’ 29 Simpson and associates,3#{176} examined the frequency of intraaneurysmal thrombi and systemic emboli in patients who underwent left ventricular aneurysmectomy. Mural thrombi were found at operation in 38 (66 percent) of their 58 patients and only two (3 percent) of the 58 had clinical events compatible with systemic emboli. These authors concluded that despite the frequent occurrence of intraaneurysmal thrombi, clinically apparent systemic emboli were rare. Before accepting the conclusion that systemic emboli are rare in patients with left ventricular aneurysms, it might be useful to examine the definitions used for left ventricular aneurysm” and “systemic emboins” in several reported studies to determine the uniformity of criteria for diagnosis. Obviously, if definitions of the two items to be analyzed vary from study to study, the results or conclusions may do likewise. Left ventricular aneurysm was defined by Simpson and associates3#{176} as”. .. an abnormally thinned, scarred, or bulging segment of left ventricular free wall noted at the time of surgery;” by Cheng’2 as “. . . a local area of total lack of motion (akinesis) or of paradoxic expansile motion (dyskinesis) during systole of the ventricular wall which may vary in thickness from a paper-thin scar to full-thickness muscle;” by Hines and associatessa as”. . . a localized area of paradoxically contracting or akinetic ventricle. . .;“ by Letac and colleagues29 as “. . . a sac protruding from the remaining left ventricular contour during both systole and diastole [at angiography] . . .;“ by Grondin and associates27 as “. . . an obvious diastolic bulge with a systolic paradoxical motion [at fiuroscopy or angiography] .;“ by Favaloro and colleagues’9 as”. . . a fullthickness scar tissue replacement of a large segment of the left ventricular wall, usually containing a thrombus and attached to the pericardial sac by adhesions . . . [with] a clear-cut demarcation from the rest of the left ventricle. . . . The absence of a frank bulging mass does not exclude a surgical diagnosis of ventricular aneurysm;” by Loop and associates’5 as “. . . thinned-out transmural scars that have completely lost their trabecular pattern. Although the aneurysm did not always bulge outward, the scar was localized and clearly delineated from surrounding ventricular muscle;” by Phares and colleagues as”. . . defects in the ventricular wall which demonstrate a definite bulge in the external contour of the heart, together with a thinning of the affected region;” by Schlichter and associates6 as “. . . a