Forty-four patients had resection of a chronic postinfarction left ventricular aneurysm. Operative indications were heart failure, angina, and ventricular arrhythmias. Twenty-six patients (59%) had coronary grafting in addition to aneurysmectomy. The operative mortality rate was 4.5% (2/44), and late mortality (mean follow-up, 31 months) was 17.9% (7/39). Preoperatively all patients were in New York Heart Association Functional Class III or IV; 91% were Class I or II postoperatively. Coronary bypass grafting did not increase the operative mortality rate, and long-term survival was similar between those receiving coronary grafts and those not receiving grafts. Postoperative ventriculograms were evaluated in 10 patients by means of a system of internal grids. Amount of regional myocardial contraction correlated well with the patient's postoperative functional capacity. It is concluded that ventricular aneurysmectomy in combination with coronary bypass grafting is safe and effective, resulting in marked improvement in the patients' functional capacity and longevity.