Value and limitations of cross-sectional echocardiography in the diagnosis of myocardial aneurysm1

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Cross-sectional echocardiography has been proposed as a useful technique for the diagnosis of ventricular aneurysm. To evaluate and compare its ability to differentiate aneurysm from mural scar, echocardiograms and ventriculograms were obtained in 54 patients. Thirty-seven of these patients subsequently underwent cardiac surgery and 17 had resection of a ventricular aneurysm. Diagnosis at surgery of true aneurysm versus mural scar was used to compare the accuracy of the two diagnostic techniques. Ventriculography correctly identified 16 of 17 patients (94%) who proved to have ventricular aneurysm at surgery; false-positive diagnosis was made in 3 of 37 patients (8%). Cross-sectional echocardiography was accurate in 13 of 17 cases of ventricular aneurysm (76%) and in 13 of 15 patients with anteroapical aneurysm (87%). The 2 cases of diaphragmatic ventricular aneurysm were mistaken for mural scar. A false-positive diagnosis was observed in 8%. We conclude that cross-sectional echocardiography is slightly less sensitive than ventriculography in the diagnosis of left ventricular aneurysm; both methods have a similar specificity. Echocardiography may be useful in complementing the angiographic diagnosis.



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