Aneurysm Of Left Ventricle Research Articles

RESULTS OF THE MODIFIED LEFT VENTRICLE RECONSTRUCTION WITH EVALUATION OF GEOMETRIC PARAMETERS IN POSTINFARCTION ANEURYSM OF THE HEART

Modern times, surgeons of the entire world utilize the technics of left ventricular reconstruction (LVR) developed by professor Dor V. However, oftenly the left ventricle (LV) presents with a spheric shape in postoperation period, by echocardiography. When, normally, geometry of the LV is conceptualized as a stretched ellipse with longitudinal axis directed from apex to the base of the heart. Aim. To evaluate effectiveness of modified LVR using Z-suture to create the LV apex in patients with postinfarction heart aneurysms. Material and methods . Twelve patients with anterior-septal localization of the LV aneurysm having myocardial infarction in anamnesis more than 6 months, with LV ejection fraction less 45%, underwent the modified LVR with Z-suture. Efficacy of the correction was assessed by echocardiography data in short term period till 1 month after the operation, comparing with pre-surgery data. Results . In all patients surgery proceeded successfully. Sphericity index significantly decreased in diastolic phase at basal level from 0,83±0,17 to 0,63±0,11 (p=0,05) and at apical level from 0,56±0,12 to 0,37±0,09 (p=0,01). Conical index increased at basal level from 1,26±0,06 to 1,67±0,40 (p=0,05), at middle-apical level from 1,34±0,30 to 1,4±0,34 (p=0,05). Conclusion. The modified left ventricular reconstruction with Z-suture forms the ellipsoid heart shape and is an effective method of surgery of postinfarction LV aneurysm.

A case of asymptomatic left ventricle aneurysm perforating into the right ventricle with normal coronary arteries

<b>A case of asymptomatic left ventricle aneurysm perforating into the right </b><b>ventricle with normal coronary arteries </b>

EVALUATION OF LEFT VENTRICULAR REMODELING AFTER SURGICAL RECONSTRUCTION OF POSTINFARCTION ANEURYSM

Objective: To assess the effect of left ventricle reconstruction in patients with postinfarction aneurysm on remodeling and heart failure dynamics in the immediate and long-term postoperative period. Material and methods: 162 patients with IHD who underwent myocardial infarction and chronic left aneurysm were included in the study. All the patients underwent myocardial revascularization and reconstructive intervention in the LV cavity at the National Medical Research Center named after V.А. Almazov. Two groups of patients were formed, depending on the type of surgical intervention performed. Group 1 (n = 116) included patients who underwent linear plastic surgery of the left ventricle aneurysm. Group 2 (n = 46) identified patients who underwent an intraventricular plastic aneurysm of V. Dor. Results: In the early postoperative period, a statistically significant decrease in the volume of the LV cavity was observed and the global ejection fraction changed in both study groups. In patients with a significant degree of mitral insufficiency additionally did the plastic fibrous ring. The con ducted single-factor analysis showed a statistically significant effect of correction of mitral insufficiency on CDD, DAC, and global ejection fraction. The majority of patients in both groups experienced a decrease in LV volumes in the long-term period. Predictors of unfavorable clinical course of heart failure in the long-term period were revealed: violation of contractility at the level of basal parts of the left ventricle with a decrease in the index of violation of local contractility more than 3, ejection fraction less than 35%, uncorrected mitral insufficiency II and more, increased level of natriuretic peptide 4 times from the upper limit of the norm. Conclusions: Combined operation makes it possible to improve the contractive function of left ventricular, to reduce the degree of mitral insufficiency, the functional class of heart failure.

Left Ventricular Aneurysm Repair with Endoaneurysmorrhaphy Technique: An Assessment of Two Different Ventriculotomy Closure Methods.

Left ventricular aneurysm is a serious mechanical complication of myocardial infarction and has an incidence of 10-35% after myocardial infarction. Ventricular aneurysm in patients with angina, heart failure, and ventricular arrhythmia should be surgically treated. Endoaneurysmorrhaphy is one of the repair techniques that results in better left ventricular geometry and function. After this surgical procedure the ventriculotomy is repaired either with Teflon felt strips or by direct suture of the epicardium. In this study, we described the postoperative early outcomes of two ventriculotomy closing techniques such as Teflon felt versus direct closure after aneurysm repair. This retrospective study included a total of 73 patients (mean age &gt; 70 years) with left ventricular aneurysm, who underwent endoaneurysmorrhaphy repair between 1997 and 2009. All selected patients were divided into two groups according to the ventriculotomy closure technique either by Teflon felt or direct by epicardial closure. The pre-, intra-, and postoperative results of these patients were analyzed accordingly. The postoperative early mortality rate and postoperative bleeding were not significantly different between the Teflon felt and primary closure groups (P = .246 and P = .371 respectively), but postoperative arrhythmias were significantly higher in the Teflon felt repair group (P = .049). Endoaneurysmorrhaphy is a better surgical technique in left ventricle aneurysm to restore the internal contour and preserve the surface anatomy of the ventricle. The ventriculotomy closure can be performed with two different approaches, including Teflon felt strips or by direct suture of the epicardium. Based on this study's findings, two repair techniques have similar impact on the early outcomes. However, with overall outcomes with respect to Teflon felt repair, direct closure of the ventriculotomy after endoaneurysmorrhaphy was superior.

Aneurysm of left ventricle at non-atherosclerosis lesion of coronary arteries

Aneurysm of left ventricle (ALV) is formed in each 5th patient with acute myocardial infarction in the presence of complete occlusion of the coronary artery (CA) by atherosclerotic plaque. But we noticed the formation of ALV in the absence of atherosclerotic stenosis, for patients with myocardial bridges (MB). The essence of this anomaly is the presence of systolic compression of the tunneled segment of the artery, which in itself raises doubts about its clinical significance. Due to the attitude of the medical community toward the MB, as a result of its ambiguous nature, and given the favorable long term trend, the MB is regarded as a variant of the norm. At the same time, increasing reports of cases of sudden death and myocardial infarction associated with the presence of MB demonstrates the relevance of this anomaly.

Peculiarities of vegetative regulation of heart activity and diurnal profile of blood pressure in patients with acute myocardial infarction, complicated by left ventricle aneurysm

In patients with myocardial infarction indexes of vegetative regulation of heart activity and diurnal blood pressure profile are connected with complicated trend of the disease. Aim. To study peculiarities of heart activity vegetative regulation, violations of heart rhythm and diurnal profile of blood pressure. Methods and results. In 108 patients with acute Q-wave myocardial infarction were investigated indexes of combined diurnal monitoring of ECG and blood pressure in dependence of left ventricle aneurysm formation. Conclusions. Increasing of sympatic influence of vegetative nervous system, prevalence of ventricular arrhythmias of «high grade», QT-interval length and predominantly adverse type of diurnal blood pressure profile were noticed in patients with myocardial infarction, complicated by left ventricle aneurysm.

Independent predictors of left ventricle aneurysm formation in acute period of q-wave myocardial infarction

З ціллю визначити незалежні предиктори формування гострої аневризми серця обстежено 235 хворих на Q-інфаркт міокарда. Встановлено, що незалежними предикторами формування аневризми лівого шлуночка є тривалість інтервалу QT, індекс сферичності, індекс локальної скорочувальної здатності, час уповільнення потоку раннього діастолічного наповнення лівого шлуночка, рівень матриксної металопротеїнази-9, інтерлейкіну-6 та протеїну С

Influence of renin-angiotensin-aldosterone system block on the systemic inflammation activity and left ventricle remodeling in patients with Q-myocardial infarction after thrombolysis

Aim. Inflammatory cytokines play a role in adaptive postinfarction remodeling of the heart. In order to study the influence of treatment on the condition of systemic inflammatory markers, the incidence of post-infarction aneurysm and thrombus formation in the left ventricle of patients with Q-wave myocardial infarction after thrombolytic therapy serum levels of interleukin-6, interleukin-1-beta, von-Willebrand factor, fibrinogen were studied in 92 patients with immunoassay analysis. Results and discussion. Remodeling, systolic and diastolic function of the heart were evaluated with echocardiography. Under the influence of the treatment reduction of systemic inflammatory markers activity was showed, which accompanied by improvement of left ventricular systolic function and low frequency of left ventricle aneurysm and thrombus formation.

A huge left ventricular pseudoaneurysm manifesting as acute dyspnea

Pseudoaneurysm of the left ventricle (LV) is one of the mechanic complications of myocardial infarction. This rare complication mostly stems from inferior wall of the LV. The wall of pseudoaneurysm contains pericardium and/or scar tissue but not myocardium. Transthorasic echocardiography is commonly used in clinical practice and is usually sufficient to make a diagnosis of LV pseudoaneurysm. It is important to differentiate pseudoaneurysm from true LV aneurysm. Pseudoaneursym does not contain myocardial tissue whereas true LV aneurysm does. Pseudoaneurysm also has narrow neck unlike true LV aneurysm. Urgent surgical approach is indicated because of fatal rupture. Here we report a case report of pseudoaneurysm manisfesting with acute dyspnea.

Spontaneous Multivessel Dissection in Young Woman – What is the Best Treatment Strategy?

This report describes the case of a 44 year-old female who was referred to our hospital after cardiac arrest and successful resuscitation. Coronary angiography revealed spontaneous dissection in a large segment of LM to LAD. The patient was referred to emergent coronary artery by-pass surgery. Four years later she was admitted with clinical and ECG findings for STEMI. Coronary angiography showed patent left coronary arteries, occluded venous graft to Rcx, occluded LIMA-LAD and spontaneous proximal dissection and occlusive thrombus in RCA. The vessel was successfully re-canalized and stented. Two years later the patient was admitted for coronary angio with symptoms of progressive heart failure. The diagnostic angio showed patent coronary arteries, occluded grafts and left ventricle aneurysm with EF 38% and severe MR. After discussion with the surgeons she received a mitral valve reconstruction. There are no specific guidelines how to manage these patients. For cases of multivessel disease and particularly when the left main or LADis affected, cardiac surgery/or PCI/ may be the therapy of choice. There are reported cases where treatment of LM dissection has been conducted successfully and conservatively.

Successful management of multiple infected sub-mitral aneurysms of left ventricle

Sub-mitral aneurysms are rarely reported clinical entity. Though a variety of etiologies are proposed, congenital weakness of the mitral valve annulus is the most widely accepted one. A 17-year-old boy with sub-mitral aneurysm presented with severe mitral regurgitation, which was diagnosed by echocardiography and successfully managed surgically. The aneurysm wall was positive for Staphylococcus aureus, and patient was treated with intensive antibiotics.

A variant technique for the surgical treatment of left ventricular aneurysms.

ObjectiveTo present a surgical variant technique to repair left ventricular aneurysms.MethodsAfter anesthesia, cardiopulmonary bypass, and myocardial protection with hyperkalemic tepic blood cardioplegia: 1) The left ventricle is opened through the infarct and an endocardial encircling suture is placed at the transitional zone between the scarred and normal tissue; 2) Next, the scar tissue is circumferentially plicated with deep stitches using the same suture thread, taking care to eliminate the entire septal scar; 3) Then, a second encircling suture is placed, completing the occlusion of the aneurysm, and; 4) Finally, the remaining scar tissue is oversewn with an invaginating suture, to ensure hemostasis. Myocardium revascularization is performed after correction of the left ventricle aneurysm. The same surgeon performed all the operations.ResultsRegarding the post-surgical outcome 4 patients (40%) had surgery 8 eight years ago, 2 patients (20%) were operated on over 6 years ago, and 1 patient (10%) was operated on more than 5 years ago. Three patients (30%) were in functional class I, class II in 2 patients (20%) and 2 patients (20%) with severe comorbidities remains in class III of the NYHA. There were three deaths (at four days, 15 days and eight months) in septuagenarians with acute myocardial infarction, diabetes and pulmonary emphysema.ConclusionThe technique is easy to perform, safe and it can be an option for the correction of left ventricle aneurysms.

An Extraordinary Case of Silent Extensive Anterior Wall Myocardial Infarction Complicated with Giant Left Ventricular Aneurysm and Dressler Syndrome

Early post-acute myocardial infarction (AMI) pericarditis, pericardial effusion with or without cardiac tamponade, and late post-MI pericarditis (Dressler syndrome), are the major pericardial complications after AMI. It is quite rare and estimated to be only about 0.1% in AMI patients according to a recent report, so it is easily neglected or misdiagnosed and may have tragic result to patient. Clinical features of this post-AMI complication include fever, chest pain, pericarditis and pleurisy occurring 2 to 3 weeks after AMI. Dressler syndrome is rarely associated with left ventricular aneurysm. Contrast enhanced magnetic resonance and echocardiography play important roles in diagnosis of left ventricle aneurysm. We report a 54-year-old male heavy labor worker who had asymptomatic, severe coronary artery disease, complicated with silent myocardial infarction, which resulted in large left ventricular aneurysm, and also systolic heart failure was noted. Patient was diagnosed to have Dressler syndrome after his second cardiology clinic follow-up. He received coronary angiography which revealed triple vessel disease with total occlusion of left anterior descending artery, and a giant left ventricular aneurysm was found. He received surgical intervention with Batista method and followed-up uneventfully at the cardiology clinic.

Idiopathic Left Ventricle Aneurysm

Mailing Address: Dr. Gustavo Restrepo Molina • Clinica Medellin Calle 53 N.46-38, Medellin Colombia E-mail : gustavorestrepomd@une.net.co Manuscript received November 27, 2013; revised November 28, 2013; accepted February 09, 2014. Introduction Idiopathic left ventricle aneurysm is an uncommon clinical entity and seldom described in literature which usually originates in the annular subaortic or sub-mitral region, and its non ischemic etiology remains unknown. This pathology may have different clinical presentations ranging from mitral regurgitation and heart failure to ventricular arrhythmias potentially fatal as well as sudden death. Even though the vast majority of cases were described among black population, it has also been described among Caucasian population with lower incidence though. At present, the use of multimodality images allows for better screening and characterization of the lesions. Hereinafter is presented a case report of a patient without evidence of known coronary heart disease, and presence in echocardiography and cardiac magnetic resonance imaging of aneurysmal idiopathic mitral subvalvular injury compromising the functioning of mitral valve, discarding other etiologic causes, the surgical correction being concluded with an adequate evolution after the procedure. The diagnosis was confirmed by histopathological examination, serology and immune profile study.

Pseudoaneurysm originating from left ventricle aneurysm: An autopsy case and review of literature

Rupture of the free wall of the left ventricle is a catastrophic complication of acute myocardial infarction. Rarely, free wall rupture is contained by overlying adherent pericardium, producing a pseudoaneurysm of the left ventricle. In this report, a case of a left ventricular pseudoaneurysm due to a previous myocardial infarction is described. A 55-year-old woman had a severe chest pain 11 months prior to death. No cardiac investigation was performed. Three days prior to death, she suffered from fatigue and weakness, and had a witnessed sudden cardiac death. At autopsy, a 8.5 × 10 × 8 cm pseudoaneurysm of the left ventricle was found. There was severe coronary artery atherosclerosis. There were extensive adhesions between pericardium and pseudoaneurysm wall. The cause of death was attributed to heart failure and resulting arrhythmia. The case illustrates the rare event of left ventricular pseudoaneurysm first diagnosed at forensic autopsy.

Management of the congenital aneurysm of the left ventricle associated with mitral insufficiency in a child: a case report.

The combination of congenital left ventricular aneurysm associated with mitral insufficiency is rare. We describe the case of a girl aged 11 years, bearing these two entities simultaneously. Aneurysmal resection of the left ventricle was performed with Dor technic to allow remodelation of the anatomy of the left ventricle. Mitral annuloplasty was performed through a transseptal approach. Three months after surgery, the child presents a good myocardial contractility without mitral regurgitation and normal ejection fraction.

Inferior Wall Aneurysm of the Left Ventricle and Severe Mitral Regurgitation Following Acute Myocardial Infarction

Left ventricular aneurysms are seen rarely in primary percutaneous coronary interventional era. True aneurysms are usually localized to apex of the ventricle and it\'s very rare to develop in the inferior wall. In this paper, we presented a true left ventricle aneurysm, localized at the basal inferior wall which is developed in the course of subacute inferior myocardial infarction of a 74-years-old man. Aneurysm is detected during left ventriculography. The true ventricular aneurysm and consequent severe mitral regurgitation caused by tethering of mitral aparatus are confirmed with transthoracic echocardiography.

Pseudoaneurysm of the mitral–aortic intervalvular fibrosa presenting after chest trauma and diagnosed by cardiac magnetic resonance: a case report

IntroductionAnnular subvalvular pseudoaneurysm is a rare example of left ventricle aneurysm described predominantly in young African people. These aneurysms are divided into two different types, namely, submitral or subaortic, with subaortic being the less frequent kind. The subaortic type is most often localized in the mitral–aortic intervalvular fibrosa. To the best of our knowledge, this is the first report of a mitral–aortic intervalvular fibrosa pseudoaneurysm associated with coarctation of the aorta, anomalous pulmonary venous return, bicuspid aortic valve and patent ductus arteriosus diagnosed by cardiovascular magnetic resonance.Case presentationWe report the case of a 15-year-old African-American boy with a history of mild chest trauma who underwent echocardiographic evaluation as part of an out-patient work up. The echocardiogram was suspicious for the presence of mitral-aortic intervalvular fibrosa pseudoaneurysm and cardiovascular magnetic resonance was then performed to better characterize this finding. In addition to confirming the presence of the aneurysm, cardiovascular magnetic resonance also revealed coarctation of the aorta, a bicuspid aortic valve, and anomalous pulmonary venous return.ConclusionIn our case, cardiovascular magnetic resonance was helpful in: (a) making a definite diagnosis of mitral–aortic intervalvular fibrosa pseudoaneurysm and its borders, which was not clear with an echocardiogram examination; and (b) illustrating additional associated congenital anomalies including the anomalous pulmonary venous return.

İskemik Kalp Hastalığı Cerrahi Tedavisi Sonrası Gelişen Atriyal Fibrilasyon; Bir Yıllık, Tek Merkez, Tek Cerrah Sonuçlarımız

Introduction: Postoperative atrial fibrillation is the most common arrhythmia following bypass surgery with significant morbidity, mortality and increased healthcare costs. The aim of this study is to determine the incidence and timing of atrial fibrillation, identify the risk factors covering preoperative and intraoperative periods, evaluate rate of return to sinus rhythm by disharge, and explore the impact on postoperative outcomes in a large group of patients operated in a single center by a single surgeon. Patients and Methods: Between January 2011 and January 2012, 418 patients on preoperative sinus rhythm were operated for ischemic heart disease and associated complications (left ventricle aneurysm repair and ischemic mitral insufficiency) in a single center, by a single surgeon. The preoperative, intraoperative and postoperative variables were studied. Results: The mean age of the patients were 61.92 ± 10.05, and 77.5% were male. Atrial fibrillation developed in 68 (16.3%) patients. The incidence peaked at second day. Patients with atrial fibrillation were older (p< 0.001). Gender, preoperative comorbidities, ejection fraction, left atrial diameter, preoperative beta-blocker use, leukocyte count, type of operation and intraoperative variables did not affect its occurence. Intensive care unit and hospital length of stay were longer (p< 0.05). 95.5% (n= 65) of patients were in normal sinus rhythm at discharge. Conclusion: Postoperative atrial fibrillation is a popular subject with unknowns and controversial results which may lead to wrong interpretations. We believe that every center has its own risk Yazisma Adresi/ Correspondence Dr. Ahmet Baris Durukan Umit Mahallesi 2463. Sokak No: 4/18 Yenimahalle, Ankara-Turkiye e-posta barisdurukan@yahoo.com ORIJINAL ARASTIRMA • ORIGINAL INVESTIGATION Kosuyolu Kalp Dergisi 2012;15(2):65-74 Atrial Fibrillation Following Surgical Management of Ischemic Heart Disease; One Year, Single Center, Single Surgeon Results Iskemik Kalp Hastaligi Cerrahi Tedavisi Sonrasi Gelisen Atriyal Fibrilasyon; Bir Yillik, Tek Merkez, Tek Cerrah Sonuclarimiz Kosuyolu Kalp Dergisi 2012;15(2):65-74 66 INTRODuCTION Postoperative atrial fibrillation (POAF) is the most commonly encountered rhythm disturbance following coronary artery bypass grafting (CABG) surgery with significant inhospital and future morbidity, future mortality and increased health care costs. The incidence is reported in a wide range in different studies, but POAF occurs approximately in 30% of cases following isolated CABG procedures(1-3). Despite recent advances in surgical and anesthesiological applications, its incidence has increased and is expected to rise more in future due to aging of the population. It mostly occurs within two to four days following surgery and peaks on second day(1,4). It is defined as a major morbid event due to increased incidence of minor and major thromboembolic events, hemodynamic disturbances, ventricular dysrhythmias, iatrogenic complications related to therapeutic interventions, increased intensive care unit and hospital length of stay and mortality(1). There are innumerous documented and speculated risk factors for occurence of POAF. The most consistent ones are the age, male gender, history of prior atrial fibrillation, inceased left atrial diameter, decreased ejection fraction, chronic obstructive pulmonary disease (COPD), chronic renal failure, diabetes mellitus, obesity and concomitant valvular surgery(4-6). The aim of this study is to determine the incidence and timing of POAF; identify the risk factors associated with its occurence covering the preoperative and intraoperative periods; evaluate percentage of return to sinus rhythm by discharge; and find out the impact on postoperative outcomes in a large group of patients undergoing surgery for ischemic heart disease management, in a single center, by a single surgeon. MATERIALS and METhODS Four hundred and twenty two patients were operated for ischemic heart disease and associated complications (left ventricular aneurysm and ischemic mitral insufficiency) between January 2011 and January 2012. Four patients were excluded due to preoperative existing atrial fibrillation atrial fibrillation in whom radiofrequency ablation during surgery was performed. The Hospital Ethics Committee approved the study based on retrospective data retrieval, waiving for individual consent. The patients were factors related with the population of that region. Discussion will last, but simple precautions and close monitoring will help to minimize adverse outcomes.

Measurement of the fetal isovolumetric contraction time in the fetus with a left ventricular aneurysm

We present a case of an antenatally diagnosed congenital aneurysm of the left ventricle in which fetal cardiac contractility was evaluated by measuring the fetal isovolumetric contraction time (ICT). The workup of the fetus at 26 weeks' gestation led to the identification of a left ventricle aneurysm. Initially, the value of ICT of the left ventricle indicated adequate cardiac function. However, the fetal ICT was gradually prolonged, suspecting deteriorated cardiac contractility. Following an uncomplicated term delivery, a postnatal echocardiogram showed normal cardiac function. It is considered that because of the hypokinesis of the wall of the left ventricular aneurysm, the ICT did not fully predict cardiac function in this setting.