1. Internal Left Ventricular Reconstruction
Hisayoshi Suma 
Operative Techniques in Thoracic and Cardiovascular Surgery 
Volume 7, Issue 2, Pages (May 2002)
DOI: /otct
Copyright © 2002 Elsevier Inc. Terms and Conditions

2. Fig I
Intraoperative echocardiography-guided volume reduction test, the left ventricle is dilated and poorly kinetic before cardiopulmonary bypass (A). When a cardiopulmonary bypass was instituted and the left ventricle was partially decompressed, viable area became thick and kinetic (B). This case showed good lateral wall and relatively poor septum. It could be dangerous if the lateral partial left ventriculectomy was performed in this case.
Operative Techniques in Thoracic and Cardiovascular Surgery 2002 7, DOI: ( /otct )
Copyright © 2002 Elsevier Inc. Terms and Conditions

3. 1
Under normothermic cardiopulmonary bypass and with the heart heating, the left ventricle is opened. An incision is placed from the apex to the distal diagonal coronary artery anteriorly close to the anterior papillary muscle.
Operative Techniques in Thoracic and Cardiovascular Surgery 2002 7, DOI: ( /otct )
Copyright © 2002 Elsevier Inc. Terms and Conditions

4. 2
The left ventricle is thoroughly investigated by endocardial inspection and by palpation of the contracting ventricular wall to detect the extent of the akinetic area. Endocardial interrupted mattress sutures are placed over a Teflon strip along the posterior septum from the apex to near the aortic valve. This vertical suture line is important to make the ellipsoid-shaped ventricle.
Operative Techniques in Thoracic and Cardiovascular Surgery 2002 7, DOI: ( /otct )
Copyright © 2002 Elsevier Inc. Terms and Conditions

5. 3
The anterior free wall is than excluded by placing transmyocardial interrupted mattress sutures only an over an epicardial Teflon strip.
Operative Techniques in Thoracic and Cardiovascular Surgery 2002 7, DOI: ( /otct )
Copyright © 2002 Elsevier Inc. Terms and Conditions

6. 4
These mattress sutures are secured to a Dacron patch that is a longitudinal oval shape 1–2 cm wide and 3–4 cm long.
Operative Techniques in Thoracic and Cardiovascular Surgery 2002 7, DOI: ( /otct )
Copyright © 2002 Elsevier Inc. Terms and Conditions

7. 5
After all sutures are tied (A), excluded ventricular wall is closed to obtain hemostasis (B). Mitral annuloplasty, when concomitantly performed with the ventriculoplasty, is performed under cardioplegic arrest before the left ventricle is opened. The aortic cross-clamp is then opened when the mitral reconstruction is completed so that the ventriculotomy can be performed with the heart beating. When mitral valve replacement is indicated, it can be performed through the ventriculotomy with the heart beating.
Operative Techniques in Thoracic and Cardiovascular Surgery 2002 7, DOI: ( /otct )
Copyright © 2002 Elsevier Inc. Terms and Conditions