Postinfarction Left Ventricular Aneurysm Research Articles

Аналіз коморбідних станів пацієнтів високого ризику з ускладненими формами ішемічної хвороби серця перед кардіохірургічним втручанням

Aim: To analyze comorbidity in high-risk patients with complicated forms of coronary artery disease before cardiac surgery. Materials and methods: Retrospective analysis of 160 randomly selected high-risk patients with complicated coronary artery disease who underwent open-heart surgery and were discharged from the Institute in the period from 2009 to 2019. The average age of patients was 59.06±9.8 years. All the patients underwent routine clinical and laboratory tests, electrocardiography, echocardiography, coronary angiography and cardiac surgery. Before cardiac surgery was performed risk stratification of patients on EuroSCORE II scale, according to the calculation, the severity of patients averaged 10.08%, which indicates a high risk of surgical death. The severity on the EuroSCORE II scale for patients with postinfarction left ventricular aneurysms was in average 9.9%, in patients with ischemic mitral regurgitation - 12.4%, and among patients with a combination of coronary artery disease with aortic valve disease, the risk of surgical death was in average 9, 2%. Results: When analyzing the baseline status of 160 high-risk patients with complicated forms of coronary artery disease, it was found that the average body mass index of patients was 28.9±4.04 kg/m2 [range 20.76-40.5 kg/m2], the level of glucose on admission was in average 6.8±2.6 mmol/l [range 3.4-21.6 mmol/l], serum creatinine averaged 107.2±25.2 μmol/l [range 56-207 μmol/l], and the estimated glomerular filtration rate averaged 67.9±18.03 ml/min/1.73 m2 [range 28-120 ml/min/1.73 m2]. Thus, 68 (42.5%) patients were overweight, 60 (37.5%) had obesity I-III st., 40 (25%) - type 2 diabetes mellitus, 79 (49.3%) - impaired glucose tolerance. 57 (35.6%) patients had chronic kidney disease with glomerular filtration rate <60 ml / min / 1.73 m2. Atherosclerotic stenosis of the carotid arteries >50% was diagnosed on Doppler study of brachiocephalic arteries in 35 (21.8%) patients. Varicose veins of the lower extremities C4-C6 stages had 42 (26.2%) patients. For 124 (77.5%) patients atherosclerosis of lower extremities arteries of different stages. Chronic obstructive pulmonary disease had 130 (81.2%) patients. 122 (76,2%) patients had a bad habit in the form of smoking, among which 20 (12.5%) continued smoking during hospitalization. 10 (6.25%) patients had gouty arthritis. Despite a high predicted mortality of 10.08% on the EuroSCORE II scale, all patients were discharged after successful surgery. Conclusions: Management of cardiac surgery patients with high-risk coronary artery disease in the perioperative period has its own characteristics and requires a personalized approach, taking into account not only cardiac features, but also comorbidity that have a great prognostic value

The value of perioperative ECG in patients with complicated forms of coronary artery disease

The aim: to analyze the informativeness and features of the perioperative electrocardiogram dynamics in complicated forms of coronary artery disease (CAD). Material and methods: retrospective ECG analysis of 100 randomized high-risk patients with complicated forms of CAD who underwent surgery in the National M. Amosov Institute of Cardiovascular Surgery Affiliated to National Academy of Medical Sciences of Ukraine from 2009 to 2019. All the patients included in the study were classified as high-risk group for complications and mortality and had an average risk of 8.60 % (from 5.02 % to 39.38 %) according to the EuroSCORE II scale. Results. Postinfarction left ventricular aneurysm (ALV) was localized in the anteroseptal region of the left ventricle (LV) in 94 (94 %) cases, and posterior-basal LV aneurysm (PBALV) was diagnosed in 6 (6 %) patients. Mitral insufficiency (MI) was detected in 8 (8.5 %) patients with anterior ALV and in 2 (33.3 %) cases of PBALV. Tricuspid valve insufficiency (TI) was diagnosed in 4 (4.2 %) patients with anterior ALV, and postinfarction defect of the interventricular septum (VSD) was verified in 2 (33.3 %) patients with PBALV. Diagnostics of anteroseptal ALV using ECG is highly accurate, the specificity of the method is 94 %, and the sensitivity is 95.6 %. ECG interpretation after surgery presents with certain difficulties, since nonspecific changes of the terminal part of the ventricular complex often occur that being interpreted correctly determine further treatment tactics. Positive ECG dynamics was detected in 66 (66 %) patients in the form of improved intraventricular conduction and the appearance of the R wave in leads I, avL, V2-V6, a lack of dynamics – in 11 (11 %), as a rule, in patients with complete left bundle branch block (LBBB), dry pericarditis of II–III stage was diagnosed in 23 (23 %) patients. Conclusions. ECG retains its importance and remains an informative and available method in modern cardiology. The correct ECG interpretation before surgery helps to assess the initial severity of the condition and timely correct the therapy and management tactics in the early postoperative period.

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.

The Influence of Obesity on Perioperative Course in High-Risk Patients with Coronary Artery Disease in Cardiac Surgery

The aim. To analyze the influence of obesity on the perioperative course in high-risk patients with coronary artery disease (CAD) in cardiac surgery.
 Material and methods. Retrospective analysis of 354 randomly selected high-risk patients with CAD (ES II > 5%) who underwent surgical intervention and were discharged from the Institute in the period from 2009 to 2019. All the patients underwent routine clinical tests, ECG, echocardiography, coronary angiography and surgical revascularization of the myocardium with correction of concomitant cardiac pathology. Among the patients of the experimental group, 194 (54.8%) had CAD, 132 (37.2%) had postinfarction left ventricular aneurysm, 12 (3.3%) suffered from ischemic mitral regurgitation, 16 (4.5%) patients had CAD and aortic valve disease.
 Results. Among high-risk patients with CAD, 287 (81.07%) had BMI > 25 kg/m2. Carbohydrate metabolism disorders were found in 208 (72.4%) overweight patients. Type 2 diabetes mellitus (DM) was diagnosed in 78 (27.1%) patients, glucose intolerance was found in 130 (45.2%) cases. Risk stratification according to the ES II scale showed maximum risk (9.8%) in patients with normal body weight and the lowest risk (5.23%) in those with grade III obesity: however, the scale does not take into account anthropometric data. With the increase in body weight, the average number of grafts decreased (3.1 at a BMI of 25-35 kg/m2, 2.6 at a BMI > 40 kg/m2) and the use of internal thoracic arteries increased: 53.7% in patients with normal weight, 66.6% in those with grade III obesity. The level of blood transfusions was the highest (55.2%) in patients with normal weight, and in those with grade III obesity no blood transfusions were performed. Postoperative atrial fibrillation occurred in 14 (20.8%) patients with BMI up to 25 kg/m2, in 30 (28.03%) with BMI 30-29.9 kg/m2 and in 8 (34.7%) patients with grade II obesity. Regardless of body weight, there was a trend towards increase in glucose levels on the first postoperative day with subnormalization until discharge. Acute kidney injury was detected in 3 (4.4%) patients with normal weight, 3 (1.94%) overweight patients, 3 (2.8%) patients with grade I obesity and 1 (33.3%) patient with morbid obesity.
 Conclusions. Timely preventive measures can help to avoid serious complications even in high-risk patients with obesity. Despite the fact that overweight patients have more severe perioperative period, experience of our Institute allows to operate and treat high-risk patients successfully regardless of their body weight.

Impact of revascularization in patients with post-infarction left ventricular aneurysm and ventricular tachyarrhythmia.

BackgroundVentricular arrhythmia is a leading cause of cardiac death among patients with post‐infarction left ventricular aneurysm (PI‐LVA). The effect of coronary revascularization in PI‐LVA patients with ventricular tachyarrhythmia remains unknown. This study aims to investigate the impact of revascularization therapy on clinical outcomes in these patients.MethodsA total of 238 PI‐LVA patients were enrolled, and 59 patients were presented with sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Patients were classified into 4 groups by treatment strategies (medical or revascularization) and the presence of VT/VF: group 1 (n = 57): VT/VF− and revascularization−; group 2 (n = 122): VT/VF− and revascularization+; group 3 (n = 34): VT/VF+ and revascularization+; and group 4 (n = 25): VT/VF+ and revascularization‐. The clinical outcomes were compared, and the primary endpoint was cardiac death or heart transplantation.ResultsPatients were followed up for 45 ± 16 months, and 41 patients (17.2%) reached the primary endpoint. Kaplan–Meier analysis showed that in VT/VF− patients, revascularization associated with higher cardiac survival compared with medical therapy (log‐rank p = .002), but in VT/VF+ patients, revascularization did not predict better cardiac outcome (log‐rank p = .901). Cox regression analysis revealed PET‐EF (HR 4.41, 95% CI: 1.72–11.36, p = .002) and moderate/severe mitral regurgitation (HR 2.32, 95% CI: 1.02–5.30, p = .046) as independent predictors of adverse cardiac outcome in patients with VT/VF.ConclusionPI‐LVA patients with VT/VF are at high risk of adverse cardiac outcome, and coronary revascularization does not mitigate this risk, although revascularization was associated with higher cardiac survival in PI‐LVA patients without VT/VF.

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.

Clinical analysis of surgical treatment of post-infarction left ventricular aneurysm: a series of 254 patients

Objective: To examine the efficacy of two surgical procedures on post-infarction left ventricular aneurysm. Methods: The clinic data of 254 patients with post-infarction left ventricular aneurysm, who underwent surgical ventricular reconstruction between January 1997 and December 2019 in Department of Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University was analyzed retrospectively. There were 183 males and 71 females aged from 31 to 81 years, with a median age of 64.6 years. Based on the size of the ventricular aneurysm, there were 73 patient received linear reconstruction (linear group) and 181 patients received endoventricular patch plasty technique (patch plasty group). Ejection fraction, left ventricular systolic and end diastolic volume and left ventricular systolic and end diastolic volume index were recorded preoperatively, 2-week, 3-month, 1-year and 5-year after operation. The survival curves were plotted with Kaplan-Meier method and the survival rates were compared by Log-rank test. Results: All patients underwent surgery with a mean cardiopulmonay bypass duration of (92±32) minutes (44 to 196 minutes) and aortic cross clamp duration of (67±22) minutes (33 to 152 minutes).There were 9 perioperative deaths with a mortality rate of 3.5%. Angina pectoris of other cases are relief and heart function improved greatly. Five years after operation, the percentage of cardiac function (New Yord Heart Association) class Ⅲ to Ⅳ patients decreased from 96.1%(244/254) to 9.9%(16/161). There was no significant difference in survival rate between linear group and patch plasty group at 1-, 3-, 5-years postoperatively (96%, 91%, 77% vs. 96%, 90%, 79%, P=0.562). Ejection fraction increased from (39±10)% (range: 22% to 50%) preoperatively to (46±6)% (range: 39% to 54%) 1-year postoperatively in the linear group, while increased from (38±13)% (range: 26% to 51%) preoperatively to (50±6)% (range: 39% to 55%) in the patch plasty group. Conclusions: Left ventricular reconstruction is quite effective for patients with post-infarction left ventricular aneurysm. The choice of operative approaches is determined by the size and range of ventricular aneurysm. Both linear reconstruction and endoventricular patch plasty technique can got similarly surgical outcomes with near and late curative effect.

P1596 Pulmonary hypertension in cardiology practice: clinical echocardiographic evaluation

Abstract Purpose To study the clinical echocardiographic features of various variants of pulmonary hypertension (PH). Methods of research. Clinical evaluation and analysis of the results of 45,000 Doppler echocardiographic studies were performed. Moderate PH corresponded to the mean pulmonary artery pressure (MPAP) level up to 50 mm Hg, severe PH was characterized by MPAP above 50 mm Hg. Results Clinically significant moderate and severe PH was established in 283 patients, which was 0.63% of the examined patients. Severe PH was detected in 106 patients, including 30 men and 76 women, whose average age was 43.1 ± 1.7 years in the age range of 14-75 years. Patients with congenital heart disease (CHD) represented the majority of the patients with severe pulmonary arterial hypertension (PAH) - 49 people (10 men and 39 women, mean age 43.0 ± 1.8 years in the age range of 14-69 years), including 16 with ventricular septal defect, 9 with an atrial septal defect, 7 with transposition of the great arteries, 6 with complete common atrioventricular canal defect, 3 with congenitally corrected transposition of the great arteries, 3 with a double outlet right ventricle, 3 with a common arterial trunk, 2 with the Ebstein anomaly. Severe PH was also established in 12 patients with idiopathic PAH, 21 patients with recurrent pulmonary embolism (PE), 10 with acquired valvular heart disease (AVHD) (in 7 cases with severe mitral stenosis, 3 with severe aortic stenosis), in 7 patients with postinfarction left ventricular aneurysm, 4 patients with chronic obstructive pulmonary disease (COPD), 3 with dilated cardiomyopathy. Moderate PH was diagnosed in 177 patients (97 men and 80 women, mean age 60.3 ± 1.3 years in the age range of 21-87 years), including 54 patients with dilated, 26 - ischemic cardiomyopathy, 38 with AVHD, 26 with PE, 17 post-MI patients, 9 with CHD, and 7 with COPD. PAH-specific therapy with bosentan and / or sildenafil was performed in 9 patients with idiopathic PAH and 7 patients with CHD without significant clinical effect; in other cases, nonspecific therapy was continued with diuretics, positive inotropic agents, and anticoagulants. Conclusions The most pronounced manifestations of PH were observed predominantly in CHD patients with advanced left-to-right and right-to-left shunting of blood, idiopathic PAH and thromboembolic PH. For prevailing venous PH, the less pronounced clinical manifestations were observed in patients with ischemic, non-coronary and valvular heart lesions, as well as with COPD accompanied by hypoxemia.

Experience of post-infarction left ventricular aneurysm reconstruction with on-pump beating heart technique

Aim. To evaluate the results of surgical treatment of post-infarction left ventricular aneurysms with on-pump beating heart technique. &#x0D; Methods. In our center from April, 2009 to January, 2014 169 patients had reconstruction of the left ventricle with on-pump beating heart technique. Among the patients 159 were males (94.1%) and 10 of them were females (5.9%), average age 53.8±8.9 years (39 to 72 years). Angina pectoris class I (according to the classification of Canadian Heart Association) was established in 7 (4.1%) patients, class II - in 49 (29.0%), class III - in 107 (63.3%), class IV - in 4 (2.4%), unstable angina in 2 (1.2%) patients. Chronic heart failure class I (according to New York Heart association functional classification) was diagnosed in 5 (3.0%) patients, class II in 37 (21.9%), class III in 124 (73.4%), class IV in 3 (1.8%) patients. Average ejection fraction of the left ventricle was 38.6±7.9% (25 to 67%). Mitral valve insufficiency stage 2-3 was revealed in 23 (13.6%) patients. &#x0D; Results. Endoventriculoplasty of the left ventricle by Dor's technique was performed in 49 (29.0%) patients, auto-septoplasty of the left ventricle - 59 (34.9%) patients, linear repair in 40 (23.7%) patients. Combined surgical interventions were performed in 21 (12.4%) patients. In-hospital lethality was 2.4% (n=4). &#x0D; Conclusion. Left ventricular reconstruction with on-pump beating heart technique without cardioplegic arest is effective and safe; the method allows performing remodelling of the left ventricle and reaching the target volume parameters.

Milking-Like Effect Secondary to Dynamic Systolic Compression of Right Coronary Artery by a Postinfarction Left Ventricular Aneurysm.

Milking-Like Effect Secondary to Dynamic Systolic Compression of Right Coronary Artery by a Postinfarction Left Ventricular Aneurysm.

Prevalence and prognosis of ventricular tachycardia/ventricular fibrillation in patients with post-infarction left ventricular aneurysm: Analysis of 575 cases

BackgroundWe investigated the prevalence of ventricular tachycardia/ventricular fibrillation (VT/VF) in Post-infarction left ventricular aneurysm (PI-LVA) patients and analyze clinical outcomes in patients presenting with VT/VF. Methods575 PI-LVA patients were enrolled and investigated by logistic regression analysis. Patients with VT/VF were followed up, the composite primary endpoint was cardiac death and appropriate ICD/external shocks. ResultsThe incidence of sustained VT/VF was 11%. Logistical regression analysis showed male gender, enlarged LV end diastolic diameter (LVEDD) and higher NYHA class were correlated with VT/VF development. During follow up of 46 ± 15 months, 19 out of 62(31%) patients reached study end point. Multivariate Cox regression analysis revealed that enlarged LVEDD and moderate/severe mitral regurgitation (MR) were independently predictive of clinical outcome. ConclusionsMale gender, enlarged LVEDD and higher NYHA class associated with risk of sustained VT/VF in PI-LVA patients. Among VT/VF positive patients, enlarged LVEDD and moderate/severe MR independently predicted poor clinical prognosis.

ULTRASOUND CONTRAST IMAGING IN DIAGNOSIS OF LEFT VENTRICLE ANEURYSM WITH THROMBOSIS

Aim: to study the possibility of use of contrast-enhanced echocardiography with SonoVue™ in evaluation of the left ventricle structural features. Here we present clinical case demonstrating the use of second generation ultrasound contrast agent for assessment of the structural features of the left ventricle in patients with coronary artery disease and post-infarction left ventricular aneurysm. In the course of routine ultrasound heart study, there was no clear definition of apical endocardial borders, of left ventricular volume, aneurysm, and the presence and size of the thrombus. Ultrasound contrast agent provided clear visualization of the endocardial borders, allowing for more accurate measurements of volumes, ejection fraction, and size and volume of thrombus. Echocardiography with contrast agents significantly improves the quality of ultrasound images and enhances the diagnostic role of noninvasive diagnostics.

Хирургическая коррекция ишемической митральной недостаточности при хронической постинфарктной аневризме левого желудочка

Patients with postinfarction left ventricular aneurysm (PLVA) and mitral regurgitation rank among the most serious patient groups whose surgical treatment is associated with high risk. Development of cardiosurgery and significant improvement of surgical outcomes so far have not yet resulted in unambiguous indications and a one-for-all approach to the surgery of PLVA combined with mitral regurgitation. A broad spectrum of surgical modalities is allowed. Based on its own performance practice and capacity, each clinic opts for its own extent of aggressive approach to patient treatment. Development of new and more improved surgical treatment strategies will enable one to come much closer to the finding of optimal ways to correct PLVA with ischemic mitral insufficiency.

Repeat coronary artery bypass grafting using in combination with resection of post-infarction left ventricular aneurysm off-pump, 10 years after primary autovenous coronary artery bypass grafting.

Repeat coronary artery bypass grafting using in combination with resection of post-infarction left ventricular aneurysm off-pump, 10 years after primary autovenous coronary artery bypass grafting.

Хирургическая коррекция постинфарктной аневризмы левого желудочка у пациентов молодого возраста

Хирургическая коррекция постинфарктной аневризмы левого желудочка у пациентов молодого возраста

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.

Left Ventricular Reconstruction for Postinfarction Left Ventricular Aneurysm: Review of Surgical Techniques.

Different surgical techniques, each with its own advantages and disadvantages, have been used to reverse adverse left ventricular remodeling due to postinfarction left ventricular aneurysm. The most appropriate surgical technique depends on the location and size of the aneurysm and the scarred tissue, the patient's preoperative characteristics, and surgeon preference. This review covers the reconstructive surgical techniques for postinfarction left ventricular aneurysm.

Post infarction left ventricular aneurysm—our experience

Left ventricular aneurysms (LVAs) stand as one of the serious complications of myocardial infarction and are associated with increased mortality. Considerable differences exist regarding the optimal surgical management of LVAs. In this study, we report our single center/single surgeon experience with post infarction LVAs. This is a retrospective analysis of 25 patients, who underwent endoventricular circular patch plasty (Dor procedure) for LVAs of ischemic origin from 2009 to 2013. The demographic data was collected in addition to patients mode of presentation, New York Heart Association (NYHA) class, past medical history particularly ischemic heart disease, preoperative electrocardiography, chest X-ray, echocardiography, and coronary angiography. The postoperative functional class and the echocardiography data were also collected and analysed. All patients underwent follow-up cardiac computerized tomogram (CT) scan to calculate the sphericity index (SI). The mean age of presentation was 60.76 ± 9.57 years. Seventeen were males and eight were females. The associated comorbidities were, diabetes and hypertension. The most common presentations were, the angina and the left ventricular failure. Among the study group, two (8%) patients presented within 72 h of myocardial infarction (MI) owing to the hemodynamic instability due to ventricular septal rupture (VSR) and severe mitral regurgitation (MR), and required moderate doses of inotropes and intra-aortic balloon pump. The time of presentation in the remaining 23 (92%) patients ranged from 14 to 38 days following the MI (mean −21.36 ± 0.38 days). The preoperative mean NYHA functional class was 2.44 ± 0.71. Posterior aneurysms were predominated in our study. The mean left ventricular internal diameter in diastole (LVIDd), the left ventricular internal diameter in systole (LVIDs) and the ejection fraction (EF) were; 6.52 ± 0.40 cm, 5.24 ± 0.37 cm, and 37.44 ± 3.92% respectively. The mean end-diastolic volume (EDV) was 167 ± 28.38 ml and the mean end-systolic volume (ESV) was 87.84 ± 12.90 ml. The mean pulmonary artery systolic pressure (PASP) was 51.48 ± 5.72 mmHg. The mean tricuspid annular plane systolic excursion (TAPSE) was 11.52 ± 0.71 mm. Six cases showed mural thrombus, four had MR, and one had an associated ventricular septal defect (VSD). The coronary angiogram showed multivessel coronary artery disease in majority of patients. The hospital mortality was 8% (two cases). The mean follow-up period was 2.4 ± 0.91 years. The postoperative mean NYHA class was 1.76 ± 0.43. There was a significant improvement in the left ventricular function. There was a significant improvement in MR following concomitant Dor procedure and mitral valve interventions. Patients with mitral interventions had trivial to mild MR and were asymptomatic. The mean SI was 0.5 ± 0.11. Dor procedure is reproducible and simple to perform, restores the natural left ventricular geometry and is associated with significant improvement in the left ventricular performance and hemodynamics, which translates into improved functional class of the patient.

Хирургическое лечение тромбированной постинфарктной аневризмы левого желудочка в условиях параллельной перфузии у пациента молодого возраста с интактными коронарными артериями

В последнее время отмечается увеличение числа молодых пациентов с ишемической болезнью сердца. Результаты недавних исследований показали высокую частоту встречаемости у молодых пациентов постинфарктных аневризм, что требует выполнения геометрической реконструкции полости левого желудочка, а это, в свою очередь, сопряжено с более высоким операционным риском. Автором представлен случай успешного хирургического лечения тромбированной постинфарктной аневризмы в условиях параллельной перфузии у пациента 34 лет с интактными коронарными артериями.