Anatomical vs 'functional' left ventricular aneurysm: Angiographic differentiation and management implication

Accurate diagnosis of the type of the left ventricular aneurysm (LVA) is essential for selection of appropriate surgical therapy. To assess the efficacy of angiography including conventional and dynamic ventriculography and coronary angiography in determining the LVA nature, 41 consecutive patients with various types of LVA, proven by surgery or autopsy, were evaluated. In all 22 patients with a 'true', anatomical LVA, the angiographic diagnosis was correct. Nineteen patients had a 'functional' LVA. In 16 of them studied by all three methods, the determination of the underlying pathologic process in the regions of wall motion abnormalities was correct; it corresponded to the findings at surgery in 15 patients, at autopsy in 1 patient, and also to follow-up angiographic studies in 12 patients. False diagnoses of an anatomical LVA were made at the beginning of the series in 3 patients in whom dynamic ventriculography was not used. On the basis of reported experience and review of the literature, findings important for differential diagnosis of individual lesions are emphasized. It is concluded, that a comprehensive evaluation of conventional left ventriculography complemented when necessary by dynamic ventriculography, together with coronary angiography, enables an accurate diagnosis in most cases. It is suggested that the term LVA be used for an anatomical aneurysm only; in patients with 'functional' LVA an attempt should be made to determine the nature of the underlying processes, in particular to differentiate reversible from irreversible wall motion abnormalities.