Traumatic left ventricular aneurysm. Two cases with normal coronary angiograms.

Two young males had traumatic left ventricular aneurysm and normal coronary angiograms. Trauma was penetrating (bullet) in one and nonpenetrating (fist blow) in the other. Recurrent ventricular tachycardia in one and a systemic embolus in the other required aneurysmectomy. The patients are free of symptoms 42 and 21 months after surgery. The presence of traumatic ventricular aneurysm and normal coronary angiograms suggests that myocardial necrosis following chest trauma is often caused by direct injury to the myocardium rather than by injury to occlusion of the coronary arteries. Therefore, coronary artery bypass surgery may be unnecessary or even hazardous in persons with chest trauma and evidence of early myocardial necrosis.