Ventricular Plasty Research Articles

Perioperative changes of the slope in the preload recruitable stroke work relationship by a single-beat technique after mitral valve surgery in functional mitral regurgitation with non-ischemic dilated cardiomyopathy.

The slope in the preload recruitable stroke work relationship is a highly linear, load-insensitive contractile parameter. However, the perioperative change of the slope has not been reported before. We examined the perioperative slope from a steady-state single beat in patients with functional mitral regurgitation and assessed the correlation with brain natriuretic peptide (BNP) levels. The study included 16 patients with non-ischemic dilated cardiomyopathy and refractory heart failure: 10 patients underwent mitral valve plasty and left ventricular plasty (MVP + LVP group) and 6 patients who underwent mitral valve replacement and papillary muscle tugging approximation (MVR + PMTA group). The left ventricular ejection fraction was assessed by the modified Simpson method; the slope was assessed by the single-beat technique using transthoracic echocardiography. BNP levels were measured by chemiluminescent immunoassay. The left ventricular ejection fraction and slope did not significantly change from pre- to early post-surgery in the MVP + LVP group. Both the left ventricular ejection fraction and slope significantly increased 6months after surgery in the MVR + PMTA group. Postoperative BNP level was low in the MVR + PMTA group. While the postoperative left ventricular ejection fraction did not correlate with BNP levels, the postoperative slope significantly correlated with BNP level after surgery in the MVP + LVP group and in the total functional mitral regurgitation group. The change of slope was dependent on surgical procedures. In functional mitral regurgitation, the slope may be a more sensitive parameter in reflecting the left ventricular contractile function than the left ventricular ejection fraction.

The problem of preoperative left ventricular modeling

Coronary heart disease has one of the leading places in the structure of cardiovascular diseases. Post-infarction left ventricular aneurysm significantly aggravates the prognosis of coronary heart disease. The main goals of surgical treatment of postinfarction left ventricular aneurysm are the maximal removal of asynergia areas and restore of correct geometry of left ventricle. Choice of left ventricular plasty technique should be individual for each patient based on instrumental examination data. Considering disadvantages of echocardiographic preoperative left ventricular modeling, attempts to model the left ventricular cavity via magnetic resonance imaging are developing at present time. Development of algorithms of left ventricular modeling by magnetic resonance imaging will optimize left ventricular reconstructive techniques and will help to avoid unfounded correction in some cases.

Successful Detection and Surgical Treatment of Cardiac Hemangioma With Right Ventricular Invasion

Cardiac hemangiomas are extremely rare benign tumors. These tumors are usually asymptomatic but they can present symptoms such as palpitations, shortness of breath, and arrythmia. We report the case of a 73-year-old man who presented with an abnormal shadow on chest computed tomography during follow-up for lung metastatic tumor after resection of his rectal cancer. A cardiac tumor was detected, and surgical resection and right ventricular plasty were successfully performed with the patient under cardiopulmonary bypass. Histopathologic examination revealed a benign cardiac hemangioma, which was categorized as a hemangioma of the mixed cavernous and capillary type.

Irreversible apical ballooning may also occur

British Journal of Hospital MedicineVol. 74, No. 7 CorrespondenceIrreversible apical ballooning may also occurOscar JolobeOscar JolobeSearch for more papers by this authorOscar JolobePublished Online:27 Sep 2013https://doi.org/10.12968/hmed.2013.74.7.415AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Lee PH, Song J-K, Park IK et al. (2011) Takotsubo cardiomyopathy: a case of persistent apical ballooning complicated by an apical mural thrombus. Korean J Intern Med 26: 455–9 Crossref, Medline, Google ScholarMiyata M, Nakazato K, Sakamoto N et al. (2013) Left ventricular plasty improved cardiac function in a case of takotsubo cardiomyopathy with persistent aneurysm. J Cardiol Cases 7(5): e133–6 Crossref, Google Scholar FiguresReferencesRelatedDetails 1 July 2013Volume 74Issue 7ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 27 September 2013 Published in print 1 July 2013 Information© MA Healthcare LimitedPDF download

Left ventricular plasty improved cardiac function in a case of takotsubo cardiomyopathy with persistent aneurysm

A 72-year-old woman was admitted to a local hospital due to repeated chest pain in December 2011. On admission, blood tests showed elevation of cardiac enzyme and B-type natriuretic peptide levels. Electrocardiography showed ST-segment elevation in almost all leads. Echocardiography showed akinesis in left ventricular (LV) apex, and hyperkinesis in basal LV.Urgent cardiac catheterization was performed. Coronary angiography showed no significant organic stenosis and the acetylcholine provocation test did not evoke coronary spasm. The left ventriculography revealed marked akinesis of the apical ballooning with hyperkinesis of the basal LV segments, suggesting takotsubo cardiomyopathy. Following the diagnosis, she started treatment for LV dysfunction with standard pharmacotherapy including beta blocker, aldosterone receptor blocker, and angiotensin-converting enzyme inhibitor. Even after 3 months, echocardiography demonstrated that LV wall motion was not recovered, and her symptoms of heart failure were not improved. Based on these findings, we considered that surgical LV plasty was necessary for the treatment of cardiac dysfunction in this patient. She underwent surgical operation (aneurysma resection and LV volume reduction) in April 2011. Pathological examination of the excised myocardial tissue from the aneurysm revealed damaged cardiomyocytes replaced with interstitial fibrosis and adipose tissue. After surgery, her LV systolic function and clinical symptoms dramatically improved.<Learning objective: Generally, patients with takotsubo cardiomyopathy have a favorable prognosis because the wall motion abnormality returns to normal without severe complications. There are only a few cases where surgical interventions were applied for takotsubo cardiomyopathy. This is an interesting case suffered from persistent severe heart failure and underwent surgical LV plasty for the LV aneurysm. After surgery, her LV systolic function and clinical symptoms dramatically improved. Pathological findings of the resected LV tissue showed that fibrosis and adipose tissue replaced myocardial fibers.>

Original Papillary Muscle Sandwich Plasty for Ischemic Mitral Regurgitation

Mitral valve plasty for functional ischemic mitral regurgitation (MR) is still a controversial procedure. The present study was a review of 23 patients who underwent an original technique known as "papillary muscle sandwich plasty" in which the mitral valve is approached via either the left atrium or left ventricle. The heads of the papillary muscles of the anterior leaflet and leaflets are plicated using Teflon-pledgeted 3-0 Ticron sutures in both the anterolateral and posteromedial commissural portions. Postoperative residual mild MR occurred in 1 patient (4%), but moderate or severe MR was not observed. In the follow-up study, prominent MR occurred in 1 patients and the MR-free rate at 2 years after surgery was 93%. Late cardiac death was significantly (P<0.05) fewer in patients without prominent MR than that in patients with MR. "Sandwich plasty" is an effective technique for patients requiring left ventricular plasty and may improve the prognosis of ischemic heart failure.

Abstract 2262: No Impact Of The Mitral Annuloplasty On Overall Survival In Patients With Ischemic Cardiomyopathy - Long-term Follow-up Study.

Good long-term results are reported after the mitral valve (MV) repair for ischemic regurgitation. The aim of the study was to identify predictors of the overall survival after routine MV repair in patients with ischemic cardiomyopathy. Methods. 164 patients, 60.9±8.66 years old, with chronic ischemic mitral regurgitation and left ventricle ejection fraction (EF) = 30.7±6.04 undergoing coronary bypass with or without MV repair were prospectively followed for 5.1±1.63 years. A Cox proportional hazards model evaluated overall survival as a function of baseline age, sex, EF, mitral regurgitation jet area, left atrial area, atrial fibrillation, NYHA class, prior anterior or inferior myocardial infarction, medical comorbidities, MV repair, left ventricular plasty, left main and 3 vessel disease, venous graft to left anterior descending artery, number of grafts and year of operation. Treatment selection bias was controlled by deriving a propensity score for mitral annuloplasty. Results. Predictors included in the Cox regression model of overall survival are presented in table . The ROC curve analysis revealed EF &lt;30.0, (sensitivity and specificity - 61.7% and 59.0%, respectively) and serum creatinine &gt;1.17, (45.6% and 77.2%) as a cut-off values in the prediction of overall survival. Conclusions. There is no impact of the mitral annuloplasty on overall survival in these patients. MV repair can be safely added to coronary bypass grafting in patients with ischemic cardiomyopathy. Multivariable Cox regression analysis results

左室形成術前後の心機能評価シミュレータの開発

Myocardial infarction and dilated cardiomyopathy significantly impair patients' cardiac functions. For these diseases, l eft ventricular plasty surgery has been used as a substitution for heart transplants from the 1980s and is improved to enhance the surgical effects and safety. We present a simulation system that enables cardiovascular surgeons to estimate functional improvements of left heart due to left ventricular plasty. The cardiac functions are evaluated with a PV diagram including emax, a ratio of left ventricular pressure to volume at the end systole. A normal heart, myocardial infarction, and postoperative heart were built on the finite element method (FEM). It was assumed that the ventricular wall of the model is composed of one-layer, elastic and isotropic material. We employed the Windkessel circulation model in order to compute PV diagrams. This paper presents the modeling method of a left heart on FEM, the simulation method, and an online output of the cardiac function calculations without FEM. Realistic trends of a PV diagram before and after left ventricular plasty surgery are computed.

左室形成術学習システムの開発(医療・福祉ロボティクス・メカトロニクス3)

左室形成術学習システムの開発(医療・福祉ロボティクス・メカトロニクス3)