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A 62-year-old male developed a large posterior left ventricular aneurysm diagnosed 6 months after a sustained myocardial infarction. Coronary angiography revealed a proximal occlusion of the circumflex artery, two 75% stenoses of the right coronary artery and a normal left anterior descending artery. The main clinical indication for surgery was residual bouts of ventricular tachycardia. A successful "mechanical conversion" of this arrhythmia by means of light precordial knocks in the apex region is reported. In this way the patient could be prepared for surgery without using myocardial depressant drugs. The aneurysm was resected, encircling endocardial ventriculotomy was performed and the right coronary artery was grafted. Nine months after the operation the patient is well without the need for antiarrhythmic drugs. The rarity of this condition is stressed and the possible mechanisms of ventricular tachycardia and its treatment in this particular case are discussed.

In the first postoperative week following aortic valve implantation, arrhythmias and conduction disturbances were seen in 37 of 44 patients studied. Sixty-seven episodes of arrhythmias occurred, atrial fibrillation and accelerated junctional rhythms accounted for more than 75% of these episodes. Episodes of atrial fibrillation were most common after the age of sixty. When atrial premature contractions were observed, episodes of atrial fibrillation followed shortly afterwards. Accelerated junctional rhythms were seen in 17 patients and affected the patients haemodynamically when this dysrhythmia occurred early in the postoperative course, but improvements were seen promptly following atrial overpacing. Lidocaine was infused prophylactically for 2 days in patients with severe aortic stenosis or marked left ventricular hypertrophy. One episode of ventricular fibrillation and few incidents of ventricular extrasystoles were seen. Most conduction disturbances were transient, but bundle branch block persisted in 3 patients, and there was complete A-V block in a fourth. No causal relationship between the use of digitoxin and the frequency of arrhythmias could be established.

Cardiac performance and hemodynamics were studied with radionuclide ventriculography in 19 survivors of aneurysmectomy and encircling endocardial ventriculotomy for recurrent, sustained ventricular arrhythmia (group I). To characterize the effect of the ventriculotomy on cardiac function, comparisons were made with a similar group of patients who underwent aneurysm surgery for angina pectoris and/or congestive heart failure (group II). Functional classification revealed no difference between the groups and they achieved the same level of exercise after surgery. No intergroup difference was found postoperatively with respect to right or left ventricular ejection fraction, regional ejection fractions, peak ejection rate, cardiac index or stroke volume. Peak filling rate was also similar, as were cardiac volumes. Exercise did not change any parameter of this intergroup similarity. The authors conclude that most patients with moderately impaired left ventricular function who undergo left ventricular aneurysmectomy with encircling endocardial ventriculotomy do not differ in postoperative hemodynamics and systolic or diastolic function from those treated with simple aneurysmectomy.