For the past four decades, the standard approach to the treatment of left ventricular aneurysms has been to resect the aneurysm wall and close it in a linear fashion. During the past decade, evidence has accumulated that this simple approach may not be the most efficacious in terms of either short-term ventricular function or long-term survival and quality of life. To establish the basis against which the newer techniques are to be compared, this article describe the historical evolution of procedures designed to treat ventricular aneurysms, the pathophysiolgy of aneurysms, the standard surgical technique still used by most surgeons, and the rationale for the newer surgical approaches.