Eighteen patients with ischemic heart disease who underwent left ventricular aneurysmectomy (LVA) and concomitant mitral valve replacement (MVR) for severe mitral regurgitation during 1973-1978 were identified. Eleven patients (61%) underwent aortocoronary bypass procedures (CABG) at the same operation. All patients had New York Heart Association class III or IV symptoms of congestive heart failure; six (33%) had disabling angina pectoris and four (22%) had had life-threatening ventricular tachycardia. Surgical mortality was 11%. The survival rate at 2 and 3 years was 80% and 57%, respectivey, with a mean follow-up of 21 months (range 4-56 months). At follow-up all patients had improved symptomatically by at least one functional clas; four patients were class II and six were class 1. The mean values (+/ SEM) for preoperative cardiac index, left ventricular end-diastolic pressure and ejection fraciton were 2.0 +/- 0.1 l/min/m2, 22 +/- 2.3 mm Hg, and 30 +/- 3.5%, respectively. Postoperative right-heart catheterization in seven patients revealed no difference between preoperative and postoperative resting cardiac index and pulmonary wedge pressure, although all seven patients claimed significant improvement. Thus, although resting hemodynamics may not be altered, combined LVA, MVR and CABG can be performed with acceptable surgical risk in these seriously ill patients and can provide excellent symptomatic improvement with good long-term survival.