Left ventricular reconstruction: Early and late results

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Presentation transcript:

Left ventricular reconstruction: Early and late results Lynda L. Mickleborough, MD, Naeem Merchant, MD, Joan Ivanov, PhD, Vivek Rao, MD, Susan Carson, AHT The Journal of Thoracic and Cardiovascular Surgery Volume 128, Issue 1, Pages 27-37 (July 2004) DOI: 10.1016/j.jtcvs.2003.08.013

Figure 1 Technique of septal aneurysm patch exclusion. A, Apical aneurysm with significant thinning and aneurysmal involvement of distal septum. B, Pericardial patch sewn to the preserved normal portion of the septum on three sides. The anterior edge of the patch is pulled tight and incorporated into the anterior modified linear closure as indicated by the arrows. C, The patch effectively excludes the aneurysmal portion of the septum from the residual LV cavity and helps restore more normal conical shape of the ventricle. (Reprinted from Mickleborough LL, Merchant N, Provost Y, Carson S, Ivanov J. Ventricular reconstruction for ischemic cardiomyopathy. Ann Thorac Surg. 2003;75:S6-12; published with permission.) The Journal of Thoracic and Cardiovascular Surgery 2004 128, 27-37DOI: (10.1016/j.jtcvs.2003.08.013)

Figure 2 Preoperative (left) and postoperative magnetic resonance imaging. Preoperatively, an anteroapical aneurysm involves the distal portion of the septum; the apex is globular in shape. Postoperatively, a septal patch has excluded the aneurysmal septum and is incorporated anteriorly into the modified linear closure. The space between the patch and septal aneurysm has been filled with clot. Ventricular volume is decreased and the shape of the apex has been restored toward normal; namely, it is more conical. (Reprinted from Mickleborough LL, Merchant N, Provost Y, Carson S, Ivanov J. Ventricular reconstruction for ischemic cardiomyopathy. Ann Thorac Surg. 2003;75:S6-12; published with permission.) The Journal of Thoracic and Cardiovascular Surgery 2004 128, 27-37DOI: (10.1016/j.jtcvs.2003.08.013)

Figure 3 Histogram showing distribution of preoperative LVEF among our patient population. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 27-37DOI: (10.1016/j.jtcvs.2003.08.013)

Figure 4 Actuarial survival after ventricular reconstruction for overall population and for subgroups with and without congestive heart failure (CHF), ventricular arrhythmias (VT), hypertension, or EF less than 20%. Asterisks (*) indicate a statistically significant difference between curves as determined by the log-rank test (P < .05). Figures in parentheses at the bottom indicate number of patients left at risk at that time of follow-up. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 27-37DOI: (10.1016/j.jtcvs.2003.08.013)

Figure 5 Preoperative (left) and postoperative magnetic resonance imaging. Preoperatively, an anteroapical infarct has resulted in thinning of the distal septum. The distal portion of the ventricle is globular in shape. After repair with a septal patch, there is restoration of a more normal conical shape to the ventricle. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 27-37DOI: (10.1016/j.jtcvs.2003.08.013)