Left Ventricular Aneurysm Repair Research Articles

Emergency Sternotomy for Ruptured Left Ventricular Aneurysm A Case Report From the André Festoc Center at the “Le Luxembourg” Mother and Child Hospital in Bamako, Mali

Left ventricular aneurysm is rare. It can be spontaneous or acquired, appearing most often after a transmural myocardial infarction but can also follow cardiac operations, trauma, inflammation or infection [1]. We report the first case of a patient initially referred by the cardiology department of the CHU-ME for the surgical management of a large pericardial effusion whose immediate operative consequences were complicated by significant hemorrhage through the pericardial drain, prompting an emergency sternotomy, surgical exploration of which revealed a ruptured left ventricle aneurysm in a 14-year-old boy. In conclusion surgical repair of left ventricular aneurysm can be performed with acceptable results.

Outcomes of concomitant myectomy and left ventricular apical aneurysm repair in patients with hypertrophic cardiomyopathy

ObjectivesHypertrophic cardiomyopathy with left ventricular apical aneurysm is a phenotype associated with a 4-fold increase in the risk for sudden cardiac death. In this study, we describe the surgical outcome of concomitant apical aneurysm repair in patients undergoing transapical myectomy for hypertrophic cardiomyopathy. MethodsWe identified 67 patients with left ventricular apical aneurysms who underwent transapical myectomy and apical aneurysm repair between July 2000 and August 2020. Long-term survival was compared with that of 2746 consecutive patients undergoing transaortic septal myectomy for obstructive hypertrophic cardiomyopathy with subaortic obstruction. ResultsTransapical myectomy was indicated for midventricular obstruction (n = 44) or left ventricular remodeling for diastolic heart failure (n = 29). Preoperatively, 74.6% (n = 50) of patients were in New York Heart Association class III/IV heart failure, and 34.3% (n = 23) of patients had experienced syncope or presyncope. Atrial fibrillation was documented in 22 patients (32.8%), and episodes of ventricular arrhythmias were recorded in 30 patients (44.8%). Thrombus was present in the apical aneurysm in 6 patients. During a median (interquartile range) follow-up of 4.9 (1.8-7.6) years, the estimated 1- and 5-year survivals were 98.5% and 94.5%, respectively, which were not significantly different from that of patients undergoing transaortic septal myectomy for obstructive hypertrophic cardiomyopathy (P = .52) or an age- and sex-matched US general population (P = .40). ConclusionsApical aneurysm repair in conjunction with septal myectomy is a safe procedure, and the good long-term survival of patients suggests that the procedure may reduce cardiac-related death in this high-risk hypertrophic cardiomyopathy population.

Minimally invasive hybrid technique for left ventricular aneurysm repair surgery due to ischemic cardiomyopathy

Minimally invasive hybrid technique for left ventricular aneurysm repair surgery due to ischemic cardiomyopathy

Surgical Treatment of Cardiac Tumors Combined with Coronary Pathology

Introduction. Cardiac tumors (CT) occur in 0.3-0.7% of general population according to autopsies. The combination of CT with coronary artery disease (CAD) significantly complicates the clinical course of the disease.
 The aim. To study the frequency, features of the course and surgical treatment of patients with CT combined with CAD.
 Materials and methods. In the period from 01.01.1969 to 31.12.2020, surgical treatment of 976 patients with CT was performed at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine, and 41 (4.2%) of these patients had lesions of the coronary arteries. In 39 patients (95.1%), CT were represented by benign tumors (myxomas), in 2 (2.4%) by malignant, poorly differentiated sarcoma and immature teratoma. For the correction of the pathology of coronary vessels, a whole range of surgical methods was used: stenting of left anterior descending artery (LAD), which was performed immediately before surgery to remove CT, in 3 patients (7.3%); coronary artery bypass grafting in 35 patients (85.4%); in cases of the presence of a muscular bridge that narrowed the LAD, dissection of this structure was performed in 2 patients (4.9%); left ventricular aneurysm repair surgery in 1 patient (2.4%). In 7 patients (17.1%), the operation was performed on urgent indications.
 Results. The average number of grafted arteries was 1.9 ± 0.3 (1 to 4) per patient. There were no mortality. Of the 41 patients with coronary artery lesions with CT, there were 2 cases of acute CAD as a result of their embolism by tumor fragments. Clinical manifestations in these patients differed significantly.
 Conclusions. Occurrence of coronary artery embolism in patients with CT according to our data is 0.2% of all patients with CT. CAD accompanies tumor lesions in 4.1% of cases and is diagnosed by angiography and computed tomography. To correct the lesion of the coronary arteries in CT, the full range of surgical techniques is used, including stenting of the coronary artery (spacecraft), coronary artery bypass grafting, removal of the myocardial bridge.

Experience in the Use of Artificial Fibrillation in the Correction of Postinfarction Left Ventricular Aneurysms as the Most Appropriate Alternative to Pharmaco-Cold Protection of the Heart

Coronary heart disease (CHD) is the leading cause of death in the world. In most cases, the disease is complicated by myocardial infarction (MI) followed by the formation of a left ventricular aneurysm (LVA), ruptures of the interventricular septum, ischemic cardiomyopathy, mitral regurgitation and arrhythmias. Postinfarction left ventricu-lar aneurysm is the most common and severe complication of CHD. There are a lot of methods of LVA surgical correc-tion, including Cooley’s linear repair technique, purse-string technique of Jatene and endoventriculoplasty using the Dor technique. Over the last year, 43 left ventricular aneurysm repair surgeries were carried out at the NatioМешковаnal M. M. Amosov Institute of Cardiovascular Surgery. Depending on the comorbidities, age, left ventricular contractility and other factors, plastic correction was performed using artificial fibrillation (n = 24 [55.8%]) or cardioplegic solution (n = 19 [44.2%]) for myocardial protection. Significant difference in the mean duration of the operation, the time the patient was on the artificial circulation, the amount of inotropic support, the time of mechanical ventilation, and the contractile function of the left ventricle (LV) was observed. In group 1, where artificial left ventricular fibrillation was used for myocardial protection, the mean duration of the surgery was 1.9 ± 0.2 h shorter. Accordingly, the patient’s stay on the artificial circulation decreased by 92.2 ± 0.3 minutes. Also, the duration of mechanical ventilation was significantly shorter: 4.6 ± 0.8 hours and 7.3 ± 0.7 hours in groups 1 and 2, respectively.
 And most importantly, in the group 1 the ejection fraction increased by 2.3 ± 0.45% compared with 1.17 ± 0.43% in the group 2. However, all the other parameters were similar in both groups. This gives reason to consider artificial ven-tricular fibrillation as the most appropriate method of myocardial protection in the future.

Cardiac computed tomography for therapy targeting in surgical repair of anteroapical left ventricular aneurysms: assessment of aneurysm volume and of anticipated residual left ventricular volume

Abstract Funding Acknowledgements Type of funding sources: None. Background Surgical ventricular repair (SVR) is an established treatment option in patients with heart failure (HF) due to left ventricular (LV) aneurysms, whereby LV volume reduction is the principal therapeutic target. Precise planning therefore is essential for postoperative improvement of HF symptoms. Purpose In this study we evaluated the potential of cardiac computed tomography (CCT) to estimate the aneurysm volume and to predict the achievable residual LV volume. Methods 205 patients (11/2005-01/2016, m:w = 151:54, median 63.4 years; mean NYHA class 3.03) with anteroapical LV aneurysm underwent SVR combined with coronary artery bypass grafting (77%), mitral valve repair/replacement (19%), and LV thrombectomy (19%). CCT was performed before and 7 days after surgery. Volumetric assessment was made using dedicated software (syngo.via Cardiac Function, Siemens AG). Preoperative CCT data of 48 consecutive patients were analyzed and then matched with effectively achieved postoperative volumes. To separate the aneurysm volume in the systole and diastole a plane determined by three landmarks on borders of scared to intact LV myocardium (antero-septal, lateral and inferior) was used. In this way ensued the retrospective estimation of the aneurysm volume (AnV/AnVI) and anticipated LV end diastolic and end systolic volume (LVEDVI, LVESVI). Results Mean diastolic and systolic estimated AnV were 92 ± 56.6 ml and 83.5 ± 61.6 ml respectively. Relation of AnV to LVEDV and to LVESV was 29.2% and 38.2%, correspondingly. There was significant correlation between anticipated and effectively achieved LVEDV and LVESV (r = 0.87 and r = 0.88, respectively, p < 0.0001), and their indexed values (r = 0.83 and r = 0.83, respectively, p < 0.0001). Anticipated LVEDVI was only 10.3 ± 22.5 ml/m2 greater than achieved LVEDVI (p = 0.003), and anticipated LVESVI was only 2.4 ± 20.3 ml/m2 greater than achieved LVESVI (p = 0.433). Conclusions Estimation of aneurysm volume and anticipated postoperative LV volume allows to predict if the therapeutic targets can be successfully achieved in individual patients. Based on the CCT assessment we propose an approach for surgical planning in anterior LV aneurysms.

Subepicardial aneurysm with free wall rupture and its successful surgical intervention: a case report

BackgroundSubepicardial aneurysm (SEA) is an uncommon but potentially fatal complication of acute myocardial infarction (MI) associated with an increased risk of free wall rupture (FWR) leading to sudden death. We describe a rare case of a silent myocardial infarction complicated by SEA and subsequent FWR, resulting in cardiac tamponade.Case summaryA 68-year-old man with no previous chest symptoms presented with syncope. Cardiac computed tomography incidentally revealed a small aneurysmal cavity at the inferolateral wall of the left ventricle, which was overlooked on initial transthoracic echocardiography. Coronary angiography demonstrated a narrowed first obtuse marginal branch with coronary slow flow, suggesting that spontaneous recanalization of the occluded obtuse marginal branch induced SEA and subsequent FWR. The patient underwent an emergency left ventricular aneurysm repair. The post-operative course was uneventful, and the patient was discharged from the hospital on post-operative day 20.DiscussionThis case emphasizes the importance of prompt detection and surgical intervention for SEA. Subepicardial aneurysm should be suspected in patients with pericardial effusion and suspected MI. Cardiac computed tomography is not only useful in the detection of such cases but also facilitates the development of a successful surgical strategy.

Case Study: Using 3D Speckle Tracking Echocardiography for Left Ventricular Aneurysm Diagnosis

Nowadays magnetic resonance imaging (MRI) is a gold standard for diagnosing abnormalities of left ventricular geometry and function, however, it is not universally accessible. Furthermore, MRI is not compatible with pacemakers and similar devices. 3D speckle tracking echocardiography (3D STE) is a cutting-edge echocardiography imaging technique for myocardial deformation assessment. As such, 3D STE looks very promising for diagnosing structural complications of myocardial infarction (MI) and choosing the optimal surgical techniques.
 In this case study, we used 3D STE to assess left ventricular function in a patient with left ventricular aneurysm.
 The patient was admitted to National Amosov Institute of Cardiovascular Surgery three weeks after having a second MI (the first MI was reported 4 years ago). His coronary angiography showed diffuse coronary artery disease. 2D echocardiography (performed on Toshiba Artida) results: end-diastolic volume (EDV) 206 ml, end-systolic volume (ESV) 141 ml, ejection fraction (EF) (Simpson’s method) 31%. An object sized 2.2*1.6 cm was discovered in the apical region (left ventricular thrombus). 3D STE results: EDV 209 ml, ESV 182 ml, EF 13%. Global area strain (GAS) was considerably decreased (–13.7 %) showing the pattern of ischemic cardiomyopathy with multivessel disease. Due to several reasons, it was impossible to obtain an MRI scan, so a CT coronary angiography was performed (Toshiba Aquilion One). The results of multi-slice computed tomography (MSCT) were consistent with those of echocardiography.
 According to the results, the initial plan to resect the apical akinesia region was ruled out. The patient underwent coronary artery bypass grafting (CABG) (4 shunts), the removal of thrombi from the left ventricle (additional fresh thrombi were discovered during the surgical intervention), and left ventricular aneurysm repair under cardiopulmonary bypass. Post-treatment 3D STE results: EDV dropped to 135 ml, EF rose from 13% to 32%. GAS increased up to –20.4 %, while the strains of all segments increased to subnormal levels. The overall dynamics was positive, and the patient was discharged to undergo postoperative rehabilitation.
 The case shows that 3D STE data is consistent with CT data in patients with abnormal ventricular remodeling. 3D STE is a good method for differentiation between akinetic scar tissue and a dyskinetic left ventricular aneurysm.

Does On-Pump Beating Heart Endoaneurysmorrhaphy Have Advantages over Linear Aneurysmectomy on Arrested Heart in the Short Term?

It is still controversial which left ventricular aneurysm repair technique is optimal in terms of early and late results. This study aimed to compare early postoperative outcomes for 2 surgical treatments of postinfarction left ventricular aneurysm: linear repair technique on arrested heart versus endoaneurysmorrhaphy repair with patch plasty on beating heart. Prospectively collected data from 16 consecutive patients who underwent endoaneurysmorrhaphy repair with patch plasty on beating heart (the technique we have preferred since 2008) were compared with data from a retrospective series of 10 patients who underwent linear repair on arrested heart (the technique we preferred until 2008). All operations were performed under elective conditions. Baseline characteristics of the 2 groups were similar. Complete revascularization for all diseased vessels was achieved in all patients. Durations of cross clamping, cardiopulmonary bypass, intensive care stay, and hospital stay were longer, and postoperative ejection fraction was lower, in the linear repair group compared with the endoaneurysmorrhaphy group (P < .05 for all). Early mortality occurred in 1 patient (3.8%) in the linear repair group. Endoaneurysmorrhaphy repair with patch plasty on beating heart seems to offer advantages over the linear repair technique on arrested heart in the treatment of left ventricular aneurysms. Future large-scale prospective studies with longer follow-up are warranted to draw firm conclusions.

Surgical Endoepicardial Linear Ablation for Ventricular Tachycardia With Postinfarction Left Ventricular Aneurysm.

This retrospective study evaluated the feasibility of surgical endoepicardial linear ablation for ventricular tachycardia in patients with postinfarction left ventricular aneurysm. Sixty-four patients with multivessel coronary artery disease and left ventricular aneurysm but no mural thrombosis of the aneurysm or valve disease were treated at our institution from March 2012 through July 2015. All underwent off-pump coronary artery bypass grafting and left ventricular aneurysm repair by linear plication. Twenty-three patients (35.9%) had ventricular tachycardia and underwent surgical endoepicardial linear ablation on the beating heart guided by epicardial substrate mapping with the Carto 3 system. The remaining 41 patients (64.1%) composed the no-ablation group. The effectiveness of surgical linear ablation in the ablation group was evaluated. Safety and clinical outcomes were evaluated and compared between the groups. The ventricular tachycardia recurrence rate in the ablation group was 17.4% in the immediate postoperative period and 23.8% at last follow-up (39 ± 21 mo). Early (<30-d) mortality rates were 8.7% in the ablation group and 4.9% in the no-ablation group (P=0.41); the respective late mortality rates were 19.1% and 18% (P=0.70). Multivariate Cox regression analysis indicated that preoperatively poor left ventricular function was an independent risk factor for early and late death in both groups. The groups were similar in terms of the need for postoperative mechanical circulatory support, intensive care unit stay, and cumulative survival rate. We conclude that, for carefully selected candidates, surgical endoepicardial linear ablation combined with off-pump coronary artery bypass grafting and left ventricular aneurysm linear plication is a feasible treatment for ventricular tachycardia with postinfarction left ventricular aneurysm.

Surgical ventricular restoration of the dilated left ventricle with large left ventricular thrombus following acute decompensated heart failure: A late complication of anterior wall myocardial infarction: “Tomb of Dead Myocardium!”

There are various case reports and the original article in the literature about the formation of a left ventricular thrombus (LVT) after acute myocardial infarction as an early to a late sequel. However, there are no guidelines available for their management, as the clinical presentation of LVT is variable and there is no consensus about its management. Furthermore, there are no randomized controlled trials comparing different treatment strategies. Here, we present a case of a large LVT who presented as acute decompensated heart failure. After stabilization, he underwent surgical repair of left ventricular aneurysm and retrieval of a thrombus.

Immediate and long-term results of left ventricular aneurysm repair

Immediate and long-term results of left ventricular aneurysm repair

Impact of surgical ventricular restoration on early and long-term outcomes of patients with left ventricular aneurysm: A single-center experience.

Left ventricular aneurysm (LVA) is a common complication of myocardial infarction. However, the optimal treatment for LVA remains controversial.In this retrospective study, we analyzed the early and long-term clinical consequences of surgical ventricular restoration on 102 patients who had undergone repair between January, 2005 and January, 2015. The LVA repair approaches comprised of patch plasty (n = 28), linear repair (n = 40), and plication repair (n = 34).Patient demographics were 60.8% male, and the mean age was 60.5 ± 7.2 years. The in-hospital mortality rate was 7.8% (8/102), including 6 patients who died from low cardiac output and 2 from multiorgan failure. During the early postoperative period, left ventricular sizes significantly decreased in the patch plasty and linear repair groups compared with the plication group. In addition, all 3 repair techniques greatly ameliorated left ventricular ejection fraction (P < .05), and there was no significant difference in survival rate between groups (P = .25).Surgical ventricular restoration (linear repair, plication repair, and patch plasty) obtained equivalently appreciable outcomes for cardiac function improvement, perioperative mortality, and survival. Selection of a surgical technique for LVA patients should be optimized to individual patient conditions including the morphological characteristics of the aneurysm and ischemic scar.

Letter by Madias Regarding Article, “Early Outcomes of Repair of Left Ventricular Apical Aneurysms in Patients With Hypertrophic Cardiomyopathy”

I very much appreciated the contribution by Nguyen et al1 about the early outcomes of surgical repair of left ventricular apical aneurysms (LVA) in patients with hypertrophic cardiomyopathy (HCM), a rare occurrence as per the authors, in the patients with HCM and subaortic obstruction, but a more frequent complication in patients with apical HCM, or midventricular obstruction, variants. Considering the many adverse outcomes in patients …

Application of Circular Patch Plasty (Dor Procedure) or Linear Repair Techniques in the Treatment of Left Ventricular Aneurysms

ObjectiveThe aim of this study was to evaluate early clinical outcomes and echocardiographic measurements of the left ventricle in patients who underwent left ventricular aneurysm repair using two different techniques associated to myocardial revascularization.MethodsEighty-nine patients (74 males, 15 females; mean age 58±8.4 years; range: 41 to 80 years) underwent post-infarction left ventricular aneurysm repair and myocardial revascularization performed between 1996 and 2016. Ventricular reconstruction was performed using endoventricular circular patch plasty (Dor procedure) (n=48; group A) or linear repair technique (n=41; group B).ResultsMulti-vessel disease in 55 (61.7%) and isolated left anterior descending (LAD) disease in 34 (38.2%) patients were identified. Five (5.6%) patients underwent aneurysmectomy alone, while the remaining 84 (94.3%) patients had aneurysmectomy with bypass. The mean number of grafts per patient was 2.1±1.2 with the Dor procedure and 2.9±1.3 with the linear repair technique. In-hospital mortality occurred in 4.1% and 7.3% in group A and group B, respectively (P>0.05).ConclusionThe results of our study demonstrate that post-infarction left ventricular aneurysm repair can be performed with both techniques with acceptable surgical risk and with satisfactory hemodynamic improvement.

Survival Determinants and Improvement of Heart Failure Symptoms after Surgical Repair of Anteroapical Left Ventricular Aneurysms Guided with Multislice Computed Tomography

Survival Determinants and Improvement of Heart Failure Symptoms after Surgical Repair of Anteroapical Left Ventricular Aneurysms Guided with Multislice Computed Tomography

Improved Left Ventricular Aneurysm Repair with Cell- and Cytokine-Seeded Collagen Patches.

Background Engineered heart tissues (EHTs) present a promising alternative to current materials for surgical ventricular restoration (SVR); however, the clinical application remains limited by inadequate vascularization postimplantation. Moreover, a suitable and economic animal model for primary screening is another important issue. Methods Recently, we used 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide hydrochloride chemistry (EDC) to initiate a strengthened, cytokine-conjugated collagenous platform with a controlled degradation speed. In vitro, the biomaterial exhibited an enhanced mechanical strength maintaining a porous ultrastructure, and the constant release of cytokines promoted the proliferation of seeded human mesenchymal stem cells (hMSCs). In vivo, with the hMSC-seeded, cytokine-immobilized patch (MSCs + GF patch), we performed modified SVR for rats with left ventricular aneurysm postmyocardial infarction (MI). Overall, the rats that underwent modified SVR lost less blood and had lower mortality. After 4 weeks, the rats repaired with this cell-seeded, cytokine-immobilized patch presented preserved cardiac function, beneficial morphology, enhanced cell infiltration, and functional vessel formation compared with the cytokine-free (MSC patch), cell-free (GF patch), or blank controls (EDC patch). Furthermore, the degradable period of the collagen patch in vivo extended up to 3 months after EDC treatment. Conclusions EDC may substantially modify collagen scaffold and provide a promising and practical biomaterial for SVR.

Left Ventricular Pseudoaneurysm Dissecting into the Anterior Chest Wall: A Rare Cause of Sudden Onset Excruciating Chest Pain.

Left ventricular pseudoaneurysm (LVPA) is associated with a significant mortality rate of up to 45% in the first year after diagnosis. It is a very rare entity and hence the true incidence and natural history are not clearly known. Clinical presentation varies widely and requires a high index of suspicion for diagnosis. We report the case of a 72-year-old woman with a remote history of left ventricular aneurysm repair during coronary bypass surgery who presented to the emergency department with acute onset of left-sided chest pain and a pulsatile chest wall swelling. She was haemodynamically stable but required an intravenous morphine drip for pain control. Contrast-enhanced computed tomography of the chest showed a large LVPA dissecting through the anterior chest wall. Surgical treatment was discussed with the patient but she opted in favour of comfort care. She died 5 days later from complete rupture of the LVPA. With this report, we aim to raise the level of awareness of LVPA that could anatomically expand and rupture. Early diagnosis and timely surgical intervention is the treatment of choice.LEARNING POINTSIt is important to recognize left ventricular pseudoaneurysm as a rare cause of sudden onset chest pain in a patient with history of myocardial infarction with/without coronary artery bypass grafting and presenting with a pulsatile chest wall mass on physical examination.Echocardiography is usually used for diagnosis, which is confirmed by CT or MRI of chest, while open surgical or percutaneous closure are the available treatment options.Mortality rates are very high even with surgical treatment in these complex patients.

Posterior wall left ventricular aneurysm repair

Posterior wall aneurysms are a relatively rare form of left ventricular aneurysm that can sometimes involve the mitral valve. This tutorial illustrates the technical aspects of posterior wall left ventricular aneurysm repair.

ON-PUMP BEATING HEART MYOCARDIAL REVASCULARIZATION FOR HIGH RISK PATIENTS

107 patients with mean ejection fraction 40,6±7,4% underwent on-pump-beating heart coronary revascularization and associated procedures. There were 76 men and 31 women, with a mean age of 68,9±7,8 years. Five patients required carotid endarterectomy and twelve patients required left ventricular aneurysm repair. 5 patients underwent carotid endarterectomy and 12 patients - left ventricular aneurysm repair. The mean number of graft/patient was 2,9±0,8. Postoperatively occurred the following complications: acute ischemic stroke - 1 (0.9%), acute heart failure - 1 (0.9%), respiratory failure - 2 (1.9%) and bleeding required surgical revision - 1 (0.9%). Hospital mortality rate was 0,9% (1 of the 107 patients). On-pump beating heart technique is a safe and efficient method for coronary artery bypass grafting and associated procedures (carotid endarterectomy, left ventricular aneurysm repair).