1
|
Lorusso R, Matteucci M, Lerakis S, Ronco D, Menicanti L, Sharma SK, Moreno PR. Postmyocardial Infarction Ventricular Aneurysm: JACC Focus Seminar 5/5. J Am Coll Cardiol 2024; 83:1917-1935. [PMID: 38719371 DOI: 10.1016/j.jacc.2024.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/18/2024] [Accepted: 02/09/2024] [Indexed: 07/16/2024]
Abstract
Ventricular aneurysm represents a rare complication of transmural acute myocardial infarction, although other cardiac, congenital, or metabolic diseases may also predispose to such condition. Ventricular expansion includes all the cardiac layers, usually with a large segment involved. Adverse events include recurrent angina, reduced ventricular stroke volume with congestive heart failure, mitral regurgitation, thromboembolism, and ventricular arrhythmias. Multimodality imaging is paramount to provide comprehensive assessment, allowing for appropriate therapeutic decision-making. When indicated, surgical intervention remains the gold standard, although additional therapy (heart failure, anticoagulation, and advanced antiarrhythmic treatment) might be required. However, the STICH (Surgical Treatment for Ischemic Heart Failure) trial did not show any advantage from adding surgical ventricular reconstruction to coronary artery bypass surgery in terms of survival, rehospitalization or symptoms, compared with revascularization alone. Finally, implantable cardiac defibrillator may reduce the risk of fatal arrhythmias.
Collapse
Affiliation(s)
- Roberto Lorusso
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Matteo Matteucci
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Cardiac Surgery Unit, ASSTSette Laghi, Varese, Italy
| | - Stamatios Lerakis
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniele Ronco
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Cardiac Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Samin K Sharma
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pedro R Moreno
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Igor Palacios Fellows Foundation, Boston Massachusetts, USA.
| |
Collapse
|
2
|
Cho Y, Ueda T, Kotani S, Okada K, Ozawa K, Shimura S, Shimizu H. AATS 2023: Left ventricular restoration with scar exclusion in the surgical treatment for ischemic heart failure. Int J Cardiol 2023; 391:131277. [PMID: 37598910 DOI: 10.1016/j.ijcard.2023.131277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE Post-infarction myocardial scar as detected by cardiac magnetic resonance (CMR) is associated with adverse left ventricular (LV) remodeling and negatively affects the prognosis. We sought to analyze the impact of left ventricular restoration (LVR) with asynergic scar exclusion on long-term outcomes for patients with ischemic heart failure (IHF). METHODS From January 2005, 134 consecutive patients with IHF underwent scar-exclusive LVR. Among the 131 survivors, 108 patients had paired late gadolinium enhancement (LGE)-CMR preoperatively and one year after, and represent the study population. Patients were divided into two groups according to whether their post-LVR residual percentage of scarred LV perimeter was <35% (%Scar <35; n = 55) or more (%Scar ≥35; n = 53). We compared the two groups, by looking at LGE-CMR outcomes, and at long-term survival and cardiac event (hospitalization for cardiac causes)-free survival. RESULTS Postoperative LV end-systolic volume index decreased significantly and ejection fraction increased with significant increase in stroke volume index (P < 0.05 for both). LV diastolic function of the left atrial volume index was significantly improved in patients with residual %Scar <35 than in those with %Scar ≥35 (P interaction = 0.005). Median survival in patients with residual %Scar <35 and ≥ 35 were 8.3 (4.5-12.2) years and 6.8 (1.8-11.8) years respectively (P = 0.106). Median cardiac event-free survival in patients with %Scar <35 and ≥ 35 were 8.0 (3.9-12.1) years and 4.8 (0.8-8.8) years respectively (P < 0.001). CONCLUSIONS Scar-exclusive LVR yielded sustainable improvement in LV function and favorable long-term survival regardless of the extent of residual scar. The LVR should be performed to attain scar exclusion in the surgical treatment for IHF, which in turn might protectively affect LV diastolic function and cardiac event-free survival.
Collapse
Affiliation(s)
- Yasunori Cho
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Thoshihiko Ueda
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Sohsyu Kotani
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Kimiaki Okada
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Keisuke Ozawa
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Shinichiro Shimura
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
| |
Collapse
|
3
|
Shipulin VM, Andreev SL, Belyaeva SA, Pryakhin AS, Sukhodolo IV, Chumakova SP. Morphological and immunological markers of repeated heart remodeling after surgical reconstruction of the left ventricle in ischemic cardiomyopathy. Asian Cardiovasc Thorac Ann 2023; 31:194-201. [PMID: 36734055 DOI: 10.1177/02184923231152107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Effective treatment of patients with ischemic cardiomyopathy (ICM) is one of the most challenging issues in modern cardiac surgery. The aim of this study was to assess the state of cardiomyocytes and myocardial extracellular matrix, as well as to identify informative markers of an unfavorable prognosis for surgical treatment of ICM. MATERIALS AND METHODS We retrospectively reviewed patients who underwent surgical treatment of ICM between 2011 and 2018 at a single center. Patients were divided into groups depending on the presence of repeated left ventricle (LV) remodeling in one-year follow-up after surgical reconstruction of the LV in ICM patients. RESULTS A total of 45 patients with ICM were reviewed. The mean age of the patients was 57.9 ± 7.8 years. According to the results of the study, the area of cardiomyocyte nuclei differed statistically significantly among the regions with varying degrees of impaired local contractility (p = 0.042). According to the results of the pairwise comparison in dyskinetic areas of the myocardium, the area of cardiomyocyte nuclei was higher than in normokinetic areas (p = 0.042). A moderate positive correlation was found between the LV ejection fraction measured in one-year follow-up period after surgery and the number of CD163-positive cells (p = 0.012). CONCLUSION In the myocardium of patients with LV reverse remodeling in the long-term postoperative period, perivascular fibrosis occurs more frequently than in patients with progressive LV remodeling. The number of M2-anti-inflammatory macrophages prevails in the myocardium of the patients with reverse remodeling compared with patients with progressive remodeling.
Collapse
Affiliation(s)
- Vladimir M Shipulin
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Sergey L Andreev
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Sofia A Belyaeva
- Morphology and General Pathology Department, Siberian State Medical University, Tomsk, Russia
| | - Andrey S Pryakhin
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Irina V Sukhodolo
- Morphology and General Pathology Department, Siberian State Medical University, Tomsk, Russia
| | - Svetlana P Chumakova
- Morphology and General Pathology Department, Siberian State Medical University, Tomsk, Russia
| |
Collapse
|
4
|
Durmaz A, Düzyol Ç, Gür S, İlkeli E, Omay O. Pediatric hydatid cyst with ventricular aneurysm and surgical treatment with dor procedure, case report. J Card Surg 2022; 37:5584-5587. [PMID: 36335619 DOI: 10.1111/jocs.17132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/27/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cardiac involvement of hydatid cyst disease (HCD) is a rare presentation but may lead to life-threatening complications such as cyst rupture and should be treated surgically. METHODS A 10-year-old male patient with cranial and complicated cardiac HCD lesions that caused lower extremity peripheral arterial occlusion and aneurysmatic dilatation in the left ventricular apex is presented. RESULTS Although the patient was in the pediatric age group, the Dor procedure was successfully applied to preserve the ventricular geometry. The Dor procedure for a ventricular aneurysm caused by a cardiac hydatid cyst (CHC) was rarely applied in the pediatric age group. CONCLUSION In conclusion, this case differs from other CHCs previously reported in the literature due to the advanced stage of the disease, atypical clinical presentation, and rare complications despite the young age of the case. The surgical method used in treating the patient makes the subject more interesting.
Collapse
Affiliation(s)
- Ayşegül Durmaz
- Department of Cardiovascular Surgery, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Çağrı Düzyol
- Department of Cardiovascular Surgery, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Sibel Gür
- Department of Cardiovascular Surgery, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Ekin İlkeli
- Department of Cardiovascular Surgery, Düzce Atatürk Devlet Hastanesi, Düzce, Turkey
| | - Oğuz Omay
- Department of Cardiovascular Surgery, Kocaeli University Medical Faculty, Kocaeli, Turkey
| |
Collapse
|
5
|
Hegeman RRMJJ, Swaans MJ, van Kuijk JP, Klein P. State-of-the-Art Review: Technical and Imaging Considerations in Hybrid Transcatheter and Minimally Invasive Left Ventricular Reconstruction for Ischemic Heart Failure. J Clin Med 2022; 11:jcm11164831. [PMID: 36013071 PMCID: PMC9409787 DOI: 10.3390/jcm11164831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Negative left ventricular (LV) remodeling consequent to acute myocardial infarction (AMI) is characterized by an increase in LV volumes in the presence of a depressed LVEF. In order to restore the shape, size, and function of the LV, operative treatment options to achieve volume reduction and shape reconstruction should be considered. In the past decade, conventional surgical LV reconstruction through a full median sternotomy has evolved towards a hybrid transcatheter and less invasive LV reconstruction. In order to perform a safe and effective hybrid LV reconstruction, thorough knowledge of the technical considerations and adequate use of multimodality imaging both pre- and intraoperatively are fundamental. In addition, a comprehensive understanding of the individual procedural steps from both a cardiological and surgical point of view is required.
Collapse
Affiliation(s)
| | - Martin John Swaans
- Department of Cardiology, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| |
Collapse
|
6
|
Calafiore AM, Totaro A, Prapas S, Katsavrias K, Guarracini S, Lorusso R, Paparella D, Di Mauro M. A historical appraisal of the techniques of left ventricular volume reduction in ischemic cardiomyopathy: Who did what? J Card Surg 2021; 37:409-414. [PMID: 34812531 DOI: 10.1111/jocs.16144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
Resection or exclusion of scars following a myocardial infarction on the left anterior descending artery territory started even before the beginning of the modern era of cardiac surgery. Many techniques were developed, but there is still confusion on who did what. The original techniques underwent modifications that brought to a variety of apparently new procedures that, however, were only a "revisitation" of what described before. In some case, old techniques were reproposed and renamed, without giving credit to the surgeon that was the original designer. Herein we try to describe which are the seminal procedures and some of the most important modifications, respecting however the merit of who first communicated the procedure to the scientific world.
Collapse
Affiliation(s)
| | - Antonio Totaro
- Department of Cardiovascular Sciences Gemelli Molise, Campobasso, Italy
| | - Sotirios Prapas
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | - Kostas Katsavrias
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | | | - Roberto Lorusso
- Department of Cardiac Surgery, Santa Maria Hospital GVM, University of Foggia, Foggia, Italy
| | - Domenico Paparella
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Michele Di Mauro
- Department of Cardiac Surgery, Santa Maria Hospital GVM, University of Foggia, Foggia, Italy
| |
Collapse
|
7
|
Fatehi Hassanabad A, Wiebe K, Ali IS. Clinical and hemodynamic outcomes of the Dor procedure in adults with ischemic cardiomyopathy. J Card Surg 2021; 36:4345-4366. [PMID: 34494297 DOI: 10.1111/jocs.15968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/07/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
Ischemic cardiomyopathy continues to be a major contributor to congestive heart failure, which places a significant burden on our healthcare system. Improving medications and different coronary revascularization strategies are the mainstays in the management of ischemic cardiomyopathy. Although medications and mechanical circulatory support are playing an ever-increasing role, cardiac transplantation remains the gold standard for treating advanced heart failure. Given the small number of available and suitable donor hearts, transplantation is limited for the majority of patients. Surgical ventricular restoration has repeatedly been suggested as a viable alternative in managing heart failure in select patients, as it is believed that surgically returning the ventricle to its original dimensions is possible and associated with favorable outcomes. The purpose of this manuscript is to comprehensively review the current literature on various surgical strategies for ventricular restoration. We also contextualize the published data with respect to ventricular function, volume, structure, arrhythmias, mitral regurgitation, and clinical outcomes.
Collapse
Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kiana Wiebe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Imtiaz S Ali
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
8
|
Cho Y, Wakasa S, Usui A, Minatoya K, Arai H, Yaku H, Yamaguchi A, Komiya T, Matsumiya G, Hamano K, Saiki Y, Matsui Y. Non-heart transplant surgical approaches with mitral valve operation and surgical ventricular reconstruction for non-ischaemic dilated cardiomyopathy: a Japanese multicenter study. Gen Thorac Cardiovasc Surg 2020; 69:679-689. [PMID: 33098529 DOI: 10.1007/s11748-020-01512-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There is uncertainty over the efficacy of additional surgical ventricular reconstruction (SVR) associated with mitral valve operation for non-ischaemic dilated cardiomyopathy (DCM). This study aims to assess mid-term outcomes of these non-heart transplant surgical approaches for DCM. METHODS We reviewed retrospectively 106 patients (median age 64, 44 females) who underwent isolated mitral annular plasty (MAP; n = 34), mitral valve replacement (MVR; n = 29), and SVR associated with MAP (SVR + MAP; n = 43) for DCM, in 11 Japanese hospitals. We analysed mid-term outcomes, specifically freedom from cardiac death and cardiac event. RESULTS Hospital deaths occurred in 16 patients (15.1%) and cardiac deaths in 36 patients (34.0%) during the study period of 4.4 ± 3.5 years. Freedom from cardiac death at 7 years in patients undergoing MAP, MVR, and SVR + MAP were, respectively, 79.1%, 82.6%, and 29.5% (P < 0.0001). Freedom from cardiac event at 7 years in patients undergoing MAP, MVR, and SVR + MAP were, respectively, 42.8%, 59.9%, 22.6% (P = 0.0004). In the multivariable analyses, preoperative tricuspid regurgitation (TR) grade was the only risk factor for both cardiac death and event, whereas MVR for DCM emerged as a protective factor for cardiac event. CONCLUSIONS This study could not show any benefit of additional SVR, by means of volume reduction, to MAP, because the baseline characteristics were different even after the stratification of DCM grade. MVR can be performed with favorable mid-term outcomes even in patients with advanced DCM, while patients undergoing MAP with/without SVR had more frequent MR recurrence or cardiac events. Interestingly, the right ventricular feature is a predictor of both cardiac death and events, with the TR grade being a predictor of poor mid-term outcomes.
Collapse
Affiliation(s)
- Yasunori Cho
- Department of Cardiovascular Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokakaido University Graduate School of Medicine, Sapporo, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Tatsuhiko Komiya
- Division of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Hospital, Chiba, Japan
| | - Kimikazu Hamano
- Department of Cardiovascular Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Hokakaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
9
|
Shipulin VM, Pryakhin AS, Andreev SL, Shipulin VV, Kozlov BN. [Surgical Treatment of Ischemic Cardiomyopathy: Current State of the Problem]. ACTA ACUST UNITED AC 2019. [PMID: 31540578 DOI: 10.18087//cardio.2019.9.n329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this article we present discussion of the current state of the problem of surgical treatment of ischemic cardiomyopathy (ICM). The pathophysiological aspects of left ventricular remodeling in patients with ICM are also covered. A detailed characterization of methods for assessing the myocardial viability is given and their role in patients with ICM is shown. The problem of right ventricular dysfunction in ICM is discussed. Main attention is focused on the methods of surgical treatment of ICM. Limitations of the Surgical Treatment for Ischemic Heart Failure (STICH) study are analyzed. The article is intended for cardiologists, general practitioners and cardiac surgeons.
Collapse
Affiliation(s)
- V M Shipulin
- Сardiology Research Institute, Tomsk National Research Medical Centre, Siberian State Medical University
| | - A S Pryakhin
- Сardiology Research Institute, Tomsk National Research Medical Centre
| | - S L Andreev
- Сardiology Research Institute, Tomsk National Research Medical Centre
| | - V V Shipulin
- Сardiology Research Institute, Tomsk National Research Medical Centre
| | - B N Kozlov
- Сardiology Research Institute, Tomsk National Research Medical Centre, Siberian State Medical University
| |
Collapse
|
10
|
Doulamis IP, Perrea DN, Mastrokostopoulos G, Drakopoulou K, Voutetakis K, Tzani A, Chloroyiannis IA. A single center's experience with total arterial revascularization and spiral aneurysmorrhaphy for ischemic cardiac disease. Heart Vessels 2018; 34:906-915. [PMID: 30523442 DOI: 10.1007/s00380-018-1317-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/30/2018] [Indexed: 11/30/2022]
Abstract
The restoration of left ventricular (LV) geometry in combination with coronary artery bypass grafting for the treatment of ischemic cardiac disease remains controversial. We hereby present the experience of our center with total arterial myocardial revascularization (TAMR) and spiral aneurysmorrhaphy for ischemic heart disease. A retrospective analysis of 101 patients with advanced cardiovascular disease who underwent TAMR and spiral aneurysmorrhaphy was performed. Spiral aneurysmorrhaphy is a modification of the linear aneurysmorrhaphy and was applied to patients who had a LV aneurysm with a diameter of less than 5 cm. Peri-operative and in-hospital data were retrieved. The majority of the patients were male (87.13%) with a mean age of 63.1 years. Mean pre-operative ejection fraction (EF) was 35.7% ranging between 20 and 65%. An average of 3.23 grafts was required per patient. Early mortality was 6.93% (one intra-operative and six in-hospital deaths). Addition of concomitant valve surgery was associated with prolonged total operative, cardiopulmonary bypass and cross-clamp time (p < 0.001), increased need for blood (p = 0.012) and plasma (p = 0.038), longer intensive care unit (ICU) stay (p = 0.045) and higher rate of post-operative cerebrovascular accident (p = 0.011). Furthermore, patients with a pre-operative EF between 30 and 50% had a shorter ICU stay (p = 0.045) and LoS (p = 0.029) compared with patients with EF <30%. Early mortality and post-operative complication rates following this combined procedure are in consistency with the relevant available data suggesting its feasibility regardless of the EF or addition of concomitant surgeries. Data from the follow-up of these patients are required to examine the long-term efficacy of this surgical modality.
Collapse
Affiliation(s)
- Ilias P Doulamis
- Laboratory for Experimental Surgery and Surgical Research "N.S Christeas", Athens Medical School, National and Kapodistrian University of Athens, Agiou Thoma Str., 15b, Goudi, 11527, Athens, Greece.
| | - Despina N Perrea
- Laboratory for Experimental Surgery and Surgical Research "N.S Christeas", Athens Medical School, National and Kapodistrian University of Athens, Agiou Thoma Str., 15b, Goudi, 11527, Athens, Greece
| | | | | | | | - Aspasia Tzani
- Laboratory for Experimental Surgery and Surgical Research "N.S Christeas", Athens Medical School, National and Kapodistrian University of Athens, Agiou Thoma Str., 15b, Goudi, 11527, Athens, Greece
| | | |
Collapse
|
11
|
Kalkat MS, Dandekar U, Smallpeice C, Parmar J, Satur C, Levine A. Left Ventricular Aneurysmectomy: Tailored Scar Excision and Linear Closure. Asian Cardiovasc Thorac Ann 2016; 14:231-4. [PMID: 16714702 DOI: 10.1177/021849230601400313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Coronary artery bypass surgery with or without aneurysmectomy is used to treat patients with left ventricular aneurysm. There is debate about patient selection and the appropriate surgical technique. We analyzed the results of 102 consecutive patients who underwent left ventricular aneurysmectomy and reconstruction using a modified linear closure technique between 1992 and 2003. The mean age was 62 years, 81% of the patients were male, and 47% had an ejection fraction < 35%. The locations of the left ventricular aneurysms were anteroapical (75%), apical (21%), and posteroinferior (4%); 23% contained thrombi. Additional procedures included aortic valve replacement in 4, mitral valve repair in 1, and coronary bypass grafting in 98 patients; 3 underwent isolated repair of left ventricular aneurysm. Hospital mortality was 7% and long-term survival was 76% at a mean follow-up of 39 months. Most patients improved symptomatically postoperatively. Left ventricular aneurysm repair with tailored scar excision and a modified closure technique is associated with acceptable mortality and long-term survival.
Collapse
Affiliation(s)
- Maninder S Kalkat
- Department of Cardiothoracic Surgery, University Hospital of North Staffordshire, Stoke-on-Trent, ST4 7LN, United Kingdom.
| | | | | | | | | | | |
Collapse
|
12
|
Castelvecchio S, Menicanti L. Left ventricular reconstruction: update to left ventricular aneurysm/reshaping techniques. Multimed Man Cardiothorac Surg 2015; 2013:mmt002. [PMID: 24413001 DOI: 10.1093/mmcts/mmt002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The increase in left ventricular (LV) volume after a myocardial infarction (MI) is a component of the remodelling process and is associated with a poor clinical outcome. Hence, the current management strategy for ischaemic LV dysfunction has been aimed at reversing the remodelling process. Surgical LV reconstruction (LVR) has been introduced as an optional therapeutic strategy aimed at reducing LV volumes through the exclusion of the scar tissue, thereby restoring the physiological volume and shape and improving LV function and clinical status. Until recently, several studies have shown that surgical LVR is effective and relatively safe, with a favourable 5-year outcome. However, in spite of the large amount of reports drawn on various data sets, the additional benefit of LVR to CABG remains debated. We briefly discuss the rationale for surgically reversing LV remodelling through LVR, and, more extensively, the technique and the indications to the best of our knowledge.
Collapse
|
13
|
A large pseudoaneurysm of the left cardiac ventricle in a 57-year-old patient after urgent coronary artery bypass grafting and surgical mitral valve replacement due to acute myocardial infarction. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2015; 11:432-6. [PMID: 26336464 PMCID: PMC4349044 DOI: 10.5114/kitp.2014.47347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 03/29/2013] [Accepted: 08/14/2013] [Indexed: 11/17/2022]
Abstract
We present a rare case of a left ventricular pseudoaneurysm in a patient after inferior wall myocardial infarction. The infarction was complicated with acute mitral insufficiency, pulmonary edema, and cardiogenic shock. Urgent surgical mitral valve replacement and coronary artery bypass grafting were performed. After several months, the patient was hospitalized again because of deterioration of exercise tolerance and symptoms of acute congestive heart failure. A large pseudoaneurysm of the left ventricle was recognized and successfully treated surgically.
Collapse
|
14
|
Adhyapak SM, Menon PG, Parachuri VR, Gadabanahalli K, Bhat VR, Shetty V, Shetty D. Restoration of optimal left ventricular apical geometry and rotation following surgical ventricular restoration using rectangular patch plasty technique: a pilot study using cardiac magnetic resonance. Interact Cardiovasc Thorac Surg 2014; 19:398-405. [PMID: 24899591 DOI: 10.1093/icvts/ivu173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Clinical outcomes of surgical ventricular restoration (SVR) have been confirmed by Registry data. Accurate assessment of left ventricular (LV) morphology and function can help optimize these outcomes. METHODS LV remodelling in 7 patients (NYHA class 3 ± 1.2) with post-myocardial infarction LV aneurysms was characterized by the regional LV volume (RLVV) computed by dividing the LV in cine steady-state free precession cardiac magnetic resonance imaging (CMR) at each slice level into six radial segments. Rotation of the LV apex and base was analysed using tagged CMR. The apical conicity ratio was used to characterize the restored apical geometry. RESULTS The mean end-diastolic volume (EDV) was 174.8 ± 100.3 ml and the mean ejection fraction (EF) was 18.8 ± 7.8%. Following SVR, all patients had significant clinical improvements (NYHA Class I), and significant increases in the left ventricular ejection fraction (LVEF) to 38.8 ± 4.4%. The LV volumes and regional volumes at the base and apex decreased with a trend towards significance. The mean preoperative apical conicity ratio (ACR) was 1.90 ± 0.43 and, following SVR by endoventricular linear patch plasty (EVLPP), was 1.35 ± 0.3 (P = 0.02). The percent decrease in the ACR following SVR from baseline was 28.68 ± 10.98%. The apical EF increased from 1.19 ± 13.9 to 15.8 ± 8.2% (P = 0.028). The basal rotations improved from 3.13 ± 2.1 to 4.69 ± 2.94° (P = 0.04). The apical rotations also improved significantly from 2.48 ± 1.23 to 3.93 ± 2.45° (P = 0.05) and reversed to the normal anticlockwise direction. CONCLUSIONS SVR by geometric repair using a rectangular intracavitary patch helps restoration of a physiological apex with normalization of apical rotation reflecting a near-physiological LV function.
Collapse
Affiliation(s)
| | - Prahlad G Menon
- Department of Electrical and Computer Engineering, SYSU-CMU Joint Institute of Engineering, Pittsburgh, USA Shunde International Research Institute, Guangdong, China QuantMD LLC, Pittsburgh, USA
| | - V Rao Parachuri
- Department of Cardiac Surgery, Narayana Hrudayalya Institute of Medical Sciences, Bangalore, India
| | - Karthik Gadabanahalli
- Department of Cardiac Surgery, Narayana Hrudayalya Institute of Medical Sciences, Bangalore, India
| | - Venkat Ramana Bhat
- Department of Cardiac Surgery, Narayana Hrudayalya Institute of Medical Sciences, Bangalore, India
| | - Varun Shetty
- Department of Cardiac Surgery, Narayana Hrudayalya Institute of Medical Sciences, Bangalore, India
| | - Devi Shetty
- Department of Cardiac Surgery, Narayana Hrudayalya Institute of Medical Sciences, Bangalore, India
| |
Collapse
|
15
|
Di Mauro M, Iaco AL, Bencivenga S, Clemente D, Marcon S, Asif M, Di Saverio MC, Romano S, Gallina S, Penco M, Calafiore AM. Left ventricular surgical remodelling: is it a matter of shape or volume? Eur J Cardiothorac Surg 2014; 47:473-9; discussion 479. [DOI: 10.1093/ejcts/ezu186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
Lee LC, Genet M, Dang AB, Ge L, Guccione JM, Ratcliffe MB. Applications of computational modeling in cardiac surgery. J Card Surg 2014; 29:293-302. [PMID: 24708036 DOI: 10.1111/jocs.12332] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although computational modeling is common in many areas of science and engineering, only recently have advances in experimental techniques and medical imaging allowed this tool to be applied in cardiac surgery. Despite its infancy in cardiac surgery, computational modeling has been useful in calculating the effects of clinical devices and surgical procedures. In this review, we present several examples that demonstrate the capabilities of computational cardiac modeling in cardiac surgery. Specifically, we demonstrate its ability to simulate surgery, predict myofiber stress and pump function, and quantify changes to regional myocardial material properties. In addition, issues that would need to be resolved in order for computational modeling to play a greater role in cardiac surgery are discussed.
Collapse
Affiliation(s)
- Lik Chuan Lee
- Department of Surgery, University of California, San Francisco, California; Department of Bioengineering, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California
| | | | | | | | | | | |
Collapse
|
17
|
Adhyapak SM, Parachuri VR. Stroke volume paradox in heart failure: mathematical validation. Asian Cardiovasc Thorac Ann 2014; 22:288-95. [PMID: 24585904 DOI: 10.1177/0218492313483583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In some patients with ischemic cardiomyopathy, despite large increases in ventricular size with decreased cardiac output, the paradox of preserved stroke volume has been observed. Following surgical ventricular restoration, despite marked improvements clinically and in ventricular volumes and ejection fraction, a decrease in stroke volume was observed. METHODS 101 consecutive patients with postinfarction left ventricular aneurysms were studied by 2-dimensional echocardiography and contrast ventriculography at baseline, and 57 of these patients at 1.7 to 2.2 years (mean 1.95 ± 0.44 years) after surgical ventricular restoration. RESULTS Surgical ventricular restoration resulted in a decrease in end-diastolic volume index of 40.2 mL (95% confidence interval: 33.6-46.7) and stroke volume index of 10.0 mL (95% confidence interval: 6.6-13.5), and an increase in ejection fraction of 6.7% (95% confidence interval: 5.5-7.9). The stroke volume index had a significant linear relationship with the end-diastolic volume index at rest in patients with end-diastolic volume index < 150 mL (r = 0.64, p < 0.001). In patients with end-diastolic volume index >150 mL, this linear relationship was not seen. The change in end-diastolic volume index and stroke volume index had a significant linear relationship (r = 0.72, p < 0.001) that persisted at 1.95 years after surgery. CONCLUSIONS In ischemic cardiomyopathy, stroke volume increases linearly with increases in end-diastolic volume up to a certain magnitude of end-diastolic volume, beyond which it decreases. Hence, following surgical ventricular restoration, decreases in stroke volume are not a reflection of impaired cardiac function.
Collapse
|
18
|
Cho Y, Shimura S, Aki A, Furuya H, Odagiri S, Okada K, Ueda T. Non-heart transplant surgical approaches with left ventricular restoration and mitral valve operation for advanced ischaemic cardiomyopathy†. Eur J Cardiothorac Surg 2014; 46:849-56. [DOI: 10.1093/ejcts/ezu011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
19
|
Buckberg GD, Athanasuleas CL, Wechsler AS, Beyersdorf F, Conte JV, Strobeck JE. The STICH trial unravelled. Eur J Heart Fail 2014; 12:1024-7. [PMID: 20861131 DOI: 10.1093/eurjhf/hfq147] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gerald D. Buckberg
- Division of Cardiothoracic Surgery; David Geffen School of Medicine at UCLA; 62-258 CHS, 10833 Le Conte Avenue Los Angeles CA 90095 USA
| | | | | | | | | | | |
Collapse
|
20
|
Lee LC, Wenk JF, Zhong L, Klepach D, Zhang Z, Ge L, Ratcliffe MB, Zohdi TI, Hsu E, Navia JL, Kassab GS, Guccione JM. Analysis of patient-specific surgical ventricular restoration: importance of an ellipsoidal left ventricular geometry for diastolic and systolic function. J Appl Physiol (1985) 2013; 115:136-44. [PMID: 23640586 DOI: 10.1152/japplphysiol.00662.2012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Surgical ventricular restoration (SVR) is a procedure designed to treat heart failure by surgically excluding infarcted tissues from the dilated failing left ventricle. To elucidate and predict the effects of geometrical changes from SVR on cardiac function, we created patient-specific mathematical (finite-element) left ventricular models before and after surgery using untagged magnetic resonance images. Our results predict that the postsurgical improvement in systolic function was compromised by a decrease in diastolic distensibility in patients. These two conflicting effects typically manifested as a more depressed Starling relationship (stroke volume vs. end-diastolic pressure) after surgery. By simulating a restoration of the left ventricle back to its measured baseline sphericity, we show that both diastolic and systolic function improved. This result confirms that the increase in left ventricular sphericity commonly observed after SVR (endoventricular circular patch plasty) has a negative impact and contributes partly to the depressed Starling relationship. On the other hand, peak myofiber stress was reduced substantially (by 50%) after SVR, and the resultant left ventricular myofiber stress distribution became more uniform. This significant reduction in myofiber stress after SVR may help reduce adverse remodeling of the left ventricle. These results are consistent with the speculation proposed in the Surgical Treatment for Ischemic Heart Failure trial (20) for the neutral outcome, that "the lack of benefit seen with surgical ventricular reconstruction is that benefits anticipated from surgical reduction of left ventricular volume (reduced wall stress and improvement in systolic function) are counter-balanced by a reduction in diastolic distensibility."
Collapse
Affiliation(s)
- Lik Chuan Lee
- Department of Surgery, University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Cho Y, Ueda T, Inoue Y, Shimura S, Aki A, Furuya H, Okada K, Tanaka C. Long-term results and mid-term features of left ventricular reconstruction procedures on left ventricular volume, geometry, function and mitral regurgitation. Eur J Cardiothorac Surg 2012; 42:462-9. [DOI: 10.1093/ejcts/ezs363] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
22
|
Gründeman PF, van der Spoel TIG, Steendijk P, van Slochteren F, Cramer MJM, Doevendans PA, Pasterkamp G. Surgical left ventricular radius enlargement by patch insertion on the beating heart: a new experimental aneurysm model. Interact Cardiovasc Thorac Surg 2012; 15:10-3. [PMID: 22523129 DOI: 10.1093/icvts/ivr148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We presented a novel experimental aneurysm model for studies in left ventricular (LV) reconstruction techniques and assessed LV function. In eight pigs, the LV radius and geometry were enlarged surgically on the beating heart by inserting an aortic allograft construct. Haemodynamics and LV dimensions were assessed by echocardiography at baseline and under dobutamine stress. Surgery was successfully performed without lethal blood loss or arrhythmias. LV end-diastolic and end-systolic short-axis areas increased from 13.0 ± 1.7 to 17.0 ± 4.3 cm(2) (P = 0.001) and from 4.0 ± 0.9 to 13.0 ± 2.6 cm(2) (P = 0.001), respectively. Stroke volume decreased from 56 ± 11 to 33 ± 16 ml (P = 0.001). Incremental dobutamine infusion concurred with a biphasic response on fractional area shortening. Mitral valve insufficiency ranging from grades 2 to 4 was observed. In the pig, a novel, reproducible aneurysm model for acute cardiac dysfunction was created on the beating heart. Innovative (surgical) strategies for (staged) reconfiguration of the ventricle, e.g. adjustable Dor procedures and stepwise volume restraining cardiac support devices, can be tested for efficacy using this acute model.
Collapse
Affiliation(s)
- Paul F Gründeman
- Experimental Cardiology Laboratory, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
23
|
Adhyapak SM, Parachuri VR. Response to heart failure therapy: ventricular volume changes vs. shape changes. Asian Cardiovasc Thorac Ann 2012; 20:210-3. [PMID: 22499978 DOI: 10.1177/0218492311435821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prolate ellipsoid left ventricular geometry is crucial for its unique contraction and relaxation patterns. Perturbations in optimal cardiac function preceding overt heart failure ensue when this ellipsoid shape assumes a more spherical configuration; this is the stage when therapy should be intensified. The dynamic shape changes during the cardiac cycle in valvular regurgitation, when ventricular volumes are within the normal range, have proved that shape changes are clearly dissociated from volume changes in the early stages. In advanced heart failure, several therapeutic interventions to decrease the ventricular equator and hence the volume, have been tried with variable success. However, the ventricular shape may still be spherical, leading to suboptimal function. The aim in any therapy for heart failure should therefore be to achieve near normal left ventricular anatomy and physiology, with shape assessment as the surrogate marker of therapeutic success.
Collapse
|
24
|
Di Donato M, Castelvecchio S, Burkhoff D, Frigiola A, Raweh A, Menicanti L. Baseline Left Ventricular Volume and Shape as Determinants of Reverse Remodeling Induced by Surgical Ventricular Reconstruction. Ann Thorac Surg 2011; 92:1565-71. [DOI: 10.1016/j.athoracsur.2011.04.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 04/11/2011] [Accepted: 04/15/2011] [Indexed: 11/26/2022]
|
25
|
Cánovas SJ. Cirugía de restauración ventricular. CIRUGIA CARDIOVASCULAR 2011. [DOI: 10.1016/s1134-0096(11)70049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
26
|
Castelvecchio S, Menicanti L, Donato MD. Surgical ventricular restoration to reverse left ventricular remodeling. Curr Cardiol Rev 2011; 6:15-23. [PMID: 21286274 PMCID: PMC2845790 DOI: 10.2174/157340310790231626] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 03/06/2009] [Accepted: 03/15/2009] [Indexed: 12/14/2022] Open
Abstract
Heart failure is one of the major health care issues in the Western world. An increasing number of patients are affected, leading to a high rate of hospitalization and high costs. Even with administration of the best available medical treatment, mortality remains high. The increase in left ventricular volume after a myocardial infarction is a component of the remodeling process. Surgical Ventricular Restoration (SVR) has been introduced as an optional therapeutic strategy to reduce left ventricular volume and restore heart geometry. So far, it has been established that SVR improves cardiac function, clinical status, and survival in patients with ischemic, dilated cardiomyopathy and heart failure. Since its first description , SVR has been refined in an effort to standardize the procedure and to optimize the results. This review will discuss the rationale behind surgical reversal of LV remodeling, the SVR technique, its impact on cardiac function and survival, and future expectations.
Collapse
|
27
|
Castelvecchio S, Menicanti L, Donato MD. Cirugía de restauración ventricular para revertir el remodelado del ventrículo izquierdo. CIRUGIA CARDIOVASCULAR 2011. [DOI: 10.1016/s1134-0096(11)70052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
28
|
Lessons from a mathematical hypothesis — modification of the endoventricular circular patch plasty. Eur J Cardiothorac Surg 2011; 39:945-51. [DOI: 10.1016/j.ejcts.2010.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/10/2010] [Accepted: 09/15/2010] [Indexed: 11/19/2022] Open
|
29
|
Isomura T. Surgical left ventricular reconstruction. Gen Thorac Cardiovasc Surg 2011; 59:315-25. [DOI: 10.1007/s11748-010-0742-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 11/07/2010] [Indexed: 11/24/2022]
|
30
|
Witkowski TG, ten Brinke EA, Delgado V, Ng AC, Bertini M, Marsan NA, Ewe SH, Auger D, Yiu KH, Braun J, Klein P, Steendijk P, Versteegh MI, Klautz RJ, Bax JJ. Surgical Ventricular Restoration for Patients With Ischemic Heart Failure: Determinants of Two-Year Survival. Ann Thorac Surg 2011; 91:491-8. [DOI: 10.1016/j.athoracsur.2010.09.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 09/24/2010] [Accepted: 09/29/2010] [Indexed: 10/18/2022]
|
31
|
Fan H, Zheng Z, Feng W, Zhang Y, Jin L, Li P, Hu S. Apical conicity ratio: A new index on left ventricular apical geometry after myocardial infarction. J Thorac Cardiovasc Surg 2010; 140:1402-7.e1-3. [DOI: 10.1016/j.jtcvs.2010.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 01/10/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
|
32
|
Di Donato M, Fantini F, Toso A, Castelvecchio S, Menicanti L, Annest L, Burkhoff D. Impact of surgical ventricular reconstruction on stroke volume in patients with ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2010; 140:1325-31.e1-2. [PMID: 20381078 DOI: 10.1016/j.jtcvs.2010.01.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 12/30/2009] [Accepted: 01/18/2010] [Indexed: 10/19/2022]
|
33
|
Shanmugam G, Ali IS. Surgical Ventricular Restoration: An Operation to Reverse Remodeling - Clinical Application (Part II). Curr Cardiol Rev 2010; 5:350-9. [PMID: 21037852 PMCID: PMC2842967 DOI: 10.2174/157340309789317913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 08/11/2008] [Accepted: 08/11/2008] [Indexed: 12/04/2022] Open
Abstract
The first part of the article dealt with the basic science behind the evolution of ventricular restoration procedures and the rationale for the use of novel surgical techniques. The second part describes the preoperative workup of patients in advanced heart failure, the core information required to determine the surgical approach and the essential principles and techniques of ventricular restoration. It then examines the effects of ventricular restorative procedures on pump function and clinical outcomes, the results of the worldwide experience with ventricular restoration and concludes with more recent advances in this field.
Collapse
Affiliation(s)
- Ganesh Shanmugam
- Department of Surgery, Division of Cardiac Surgery, Dalhousie University, QEII Health Sciences Centre, Halifax Infirmary, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada
| | | |
Collapse
|
34
|
Effects of surgical ventricular reconstruction on diastolic function at midterm follow-up. J Thorac Cardiovasc Surg 2010; 140:285-291.e1. [DOI: 10.1016/j.jtcvs.2009.10.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 09/15/2009] [Accepted: 10/22/2009] [Indexed: 11/18/2022]
|
35
|
Thompson KA, Philip KJ, Barbagelata A, Schwarz ER. Review article: the new concept of interventional heart failure therapy--part 1: electrical therapy, treatment of CAD, fluid removal, and ventricular support. J Cardiovasc Pharmacol Ther 2010; 15:102-11. [PMID: 20435990 DOI: 10.1177/1074248410366447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Congestive heart failure is a chronic and debilitating disease responsible for high cardiac morbidity and mortality in the world and is associated with more than 290 000 deaths in the United States each year. Recent advances in heart failure therapy target many of the mechanical and structural aspects of heart failure that are not addressed by drug-based therapies; these include abnormalities in electrical conduction, coronary artery or valvular architecture, and in ventricular size and shape. To target these abnormalities, newer therapies have largely been mechanical and device-based in nature and can be collectively described as interventional therapy. Interventional therapy includes the use of interventional medical therapy, electrical-based devices to augment ventricular function, catheterization-based devices for the treatment of underlying coronary artery disease and valvular disease, machines for the removal of excess fluid, mechanical pumps to assist the ventricles, surgical techniques aimed at reshaping the ventricles, the use of tissue therapies such as stem cell transplantation or complete heart transplant, palliative care, and self-care. This article is the first in a 2-part series that will review interventional heart failure therapy and present the most recent data supporting its use.
Collapse
Affiliation(s)
- Keith A Thompson
- Department of Medicine, Division of Cardiology, Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | | | | | |
Collapse
|
36
|
Ballotta A, Ranucci M, Kunkl A, El Baghdady H, Bossone E, Castelvecchio S, Frigiola A, Menicanti L, Di Donato M, Mehta RH. N-terminal pro-brain natriuretic peptide and outcomes in patients undergoing surgical ventricular restoration. Am J Cardiol 2010; 105:640-4. [PMID: 20185010 DOI: 10.1016/j.amjcard.2009.10.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 10/20/2009] [Accepted: 10/20/2009] [Indexed: 10/19/2022]
Abstract
N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels have been shown to be increased at baseline in patients undergoing surgical ventricular restoration (SVR) of the left ventricle. However, changes in the values of this marker in the early postoperative period and its prognostic significance remain less known in these patients. We evaluated 31 consecutive patients undergoing SVR who had NT-pro-BNP determined a day before SVR and from postoperative days 0 to 4. Major morbidity was defined as > or =1 of the following: ventilation >48 hours, stroke, acute renal failure, low cardiac output, reoperation, or mediastinitis. The association of preoperative NT-pro-BNP with perioperative outcomes was assessed using multivariable logistic regression analysis. Receiver operating characteristic curve was used to test its discrimination power. Major morbidity occurred in 16 patients (52%) with only 1 death within 30 days of SVR. Mean preoperative NT-pro-BNP was 4.5-fold higher in patients with postoperative major morbidity than in those without it (3,022 +/- 2,981 vs 676 +/- 533 pg/ml, p = 0.007). On multivariate analysis, preoperative NT-pro-BNP was independently associated with major morbidity after adjusting for baseline confounding, particularly age, ejection fraction, and European System for Cardiac Operative Risk Evaluation (odds ratio 1.002, 95% confidence interval 1.001 to 1.003, p = 0.032). Preoperative NT-pro-BNP had a high discrimination power on receiver operating characteristic analysis for major morbidity (area under the curve 0.84, sensitivity 68%, and specificity 88% for 1,304 pg/ml). Although NT-pro-BNP levels decreased after SVR in patients without major morbidity, their levels remained persistently increased in those with it. In conclusion, preoperative NT-pro-BNP determination may be of value in stratifying the risk for major morbidity after SVR.
Collapse
|
37
|
Di Donato M, Castelvecchio S, Menicanti L. End-systolic volume following surgical ventricular reconstruction impacts survival in patients with ischaemic dilated cardiomyopathy. Eur J Heart Fail 2010; 12:375-81. [PMID: 20185429 DOI: 10.1093/eurjhf/hfq020] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS A left ventricular end-systolic volume (LVESV) > or =60 mL/m(2) has been shown to be associated with increased cardiac mortality after a reperfused myocardial infarction (MI). The reduction in LVESV following surgical ventricular reconstruction (SVR) is reported to be between 19% and 50% but its impact on prognosis is not well-established. The aim of this study was therefore to assess the impact on survival of a residual LVESV index (LVESVI) of > or = or <60 mL/m(2) following SVR. METHODS AND RESULTS All patients undergoing SVR at our Centre between July 2001 and March 2009 were eligible to be included in this study if they had a preoperative LVESVI of > or =60 mL/m(2) and an LVESVI measurement performed at discharge (7-10 days after surgery). Two hundred and sixteen patients (aged 64 +/- 9 years, 33 women) satisfied these criteria. Coronary artery bypass graft was performed in 197 patients (91.2%) and mitral repair in 63 patients (29%). Left ventricular ESVI had decreased by 41% at discharge in the overall population. Patients were grouped according to the residual LVESVI at discharge as follows: Group 1, LVESVI > or = 60 mL/m(2) (n = 71), and Group 2, LVESVI < 60 mL/m(2) (n = 145). In both groups, LVESVI decreased significantly with respect to baseline, by 29% in Group 1 and by 47% in Group 2. At multivariate analysis, the presence of a non-Q-wave MI and a preoperative internal diastolic diameter of 65 mm were the strongest predictors of a residual post-operative LVESVI of > or =60 mL/m(2). Risk of all-cause death was significantly higher in Group 1. Post-operative LVESVI of > or =60 mL/m(2) was an independent predictor of mortality at follow-up [Exp(B) = 10.7, CI: 2.67-42.9, P = 0.001]. CONCLUSION Our findings confirm the role of LVESVI in predicting survival following SVR; the lack of additional improvement in survival with SVR observed in the STICH trial might be due to the inadequate volume reduction (-19%).
Collapse
Affiliation(s)
- Marisa Di Donato
- Department of Critical Care Medicine, University of Florence, Florence, Italy.
| | | | | |
Collapse
|
38
|
Almeida RMS. Quality of Life after 114 Months of Follow-up following Geometric Reconstruction of the Left Ventricle by Endoventriculoplasty with Septal Exclusion. Heart Surg Forum 2010; 13:E40-4. [DOI: 10.1532/hsf98.20091132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: The purpose of this study was to present the surgical experience of the Institute of Cardiovascular Surgery of West of Paran (ICCOP) with respect to the treatment of left ventricle aneurysms by endoventriculoplasty with septal exclusion (EVSE) and to evaluate the quality of life of these patients after a 114-month follow-up.Methods: Between April 1999 and April 2006, 28 patients underwent EVSE. Preoperative, transoperative, and late postoperative clinical and echocardiographic variables were analyzed retrospectively. In addition, latepostoperative quality of life was evaluated with questionnaire SF-36 (Brazilian version). The mean age (SD) of the group was 59.0 9.5 years, and 23 of the patients were male. Seventeen patients were in New York Heart Association functional class IV, and the mean preoperative EuroSCORE was 8.2 2.3. The mean preoperative values for the ejection fraction (EF) and the end-systolic and end-diastolic left ventricular volumes were 32.3% 9.2%, 113.9 36.0 mL, and 179.2 48.4 mL, respectively.Results: The in-hospital mortality rate was 14.3%, with the major causes of morbidity being low cardiac output syndrome and arrhythmias. The mean follow-up period was 5.9 3.4 years. The left ventricular EF and the aortic cross-clamping time were the significant factors for hospital and late mortality (P = .0222, and P = .0123, respectively). The actuarial survival curve showed survival rates of 82.1 7.2%, and 54.7 22.9%, before and after 107 months of follow-up. The overall score for the quality of life showed an improvement.Conclusion: EVSE surgery is an effective option for treating this group of patients, with improvement noted in left ventricular function and in the patients' quality of life, despite the high in-hospital mortality.
Collapse
|
39
|
Huijgen WHF, Gründeman PF, van der Spoel T, Cramer MJ, Steendijk P, Klautz RJM, van Herwerden LA. Resizable Ventricular Patch Plasty in the Porcine Left Ventricle a Pilot Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010. [DOI: 10.1177/155698451000500105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Paul F. Gründeman
- Experimental and Clinical Cardiothoracic Surgery, University Hospital Utrecht, Utrecht, The Netherlands
| | - Tycho van der Spoel
- Department of Cardiology, University Hospital Utrecht, Utrecht, The Netherlands
| | - Maarten-Jan Cramer
- Department of Cardiology, University Hospital Utrecht, Utrecht, The Netherlands
| | - Paul Steendijk
- Department of Cardio-Thoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Robert J. M. Klautz
- Department of Cardio-Thoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Lex A. van Herwerden
- Experimental and Clinical Cardiothoracic Surgery, University Hospital Utrecht, Utrecht, The Netherlands
| |
Collapse
|
40
|
Resizable ventricular patch plasty in the porcine left ventricle: a pilot study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010; 5:16-21. [PMID: 22437271 DOI: 10.1097/imi.0b013e3181cfa8f1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE : Endoventricular circular patch plasty is a method used to reconstruct the ventricular cavity in patients with (post) ischemic left ventricular aneurysm or global dilatation. However, late redilatation with mitral regurgitation has been reported, in which postoperative apex shape seems to play an important role. We studied the feasibility of ventricular volume downsizing with a variably shaped patch in porcine hearts. METHODS : In five in vitro and two acute animal experiments, a dyskinetic aneurysm was simulated with a pericardial insert. Reducing patch surface by changing patch shape diminished end-diastolic volume. In vitro, static end-diastolic volume was determined for each patch shape using volumetry and echocardiography. In the acute animal experiments, preliminary observations of patch behavior in live material were made, and pressure/time relationship, dPdTmax, was registered. RESULTS : In vitro, bringing the convex patch into a flat plane reduced LV volume from 66 ± 7 mL (aneurysm) to 49 ± 5 mL. Four of 5 patch shapes further reduced volume to a mean of 38 ± 7 mL (P = 0.03). The in vitro echocardiographic measurements correlated with volumetry findings (r = 0.81). In the acute animal experiments, dPdTmax varied with patch shape, independent of volume changes. CONCLUSIONS : In this pilot study, in vitro shape configuration of the resizable ventricular patch resulted in a calibrated end-diastolic volume reduction. The data of the two in vivo pilot experiments clearly indicate that change in patch configuration in the situation of more or less unchanged end-diastolic volume had impact on cardiac performance. Future studies must substantiate the results of this observation.
Collapse
|
41
|
Buckberg GD, Athanasuleas CL. The STICH trial: Misguided conclusions. J Thorac Cardiovasc Surg 2009; 138:1060-1064.e2. [DOI: 10.1016/j.jtcvs.2009.07.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 06/12/2009] [Accepted: 07/07/2009] [Indexed: 10/20/2022]
|
42
|
Diabetes Mellitus and Long-Term Outcome in Heart Failure Patients After Surgical Ventricular Restoration. Ann Thorac Surg 2009; 88:1451-6. [DOI: 10.1016/j.athoracsur.2009.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 06/29/2009] [Accepted: 07/02/2009] [Indexed: 11/19/2022]
|
43
|
Jamshidi R, Hornberger LK, Karl TR. Left ventricular aneurysm in a child with severe combined immunodeficiency syndrome. Ann Thorac Surg 2009; 88:1678-80. [PMID: 19853138 DOI: 10.1016/j.athoracsur.2009.03.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 03/14/2009] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
Abstract
We describe the case of a 23-month-old girl with combined immunodeficiency syndrome and a left ventricular aneurysm. Due to the size of the aneurysm and development of an intramural thrombus, repair was performed after confirmation of bone marrow transplant engraftment. Endoventricular circular patch plasty (Dor procedure) was performed, with excellent outcome and normalization of ventricular geometry and function.
Collapse
Affiliation(s)
- Ramin Jamshidi
- Department of Surgery, UCSF Medical Center, San Francisco, California, USA
| | | | | |
Collapse
|
44
|
|
45
|
Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol 2009; 53:e1-e90. [PMID: 19358937 DOI: 10.1016/j.jacc.2008.11.013] [Citation(s) in RCA: 1185] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
46
|
Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009; 119:e391-479. [PMID: 19324966 DOI: 10.1161/circulationaha.109.192065] [Citation(s) in RCA: 1080] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
47
|
Di Donato M, Castelvecchio S, Kukulski T, Bussadori C, Giacomazzi F, Frigiola A, Menicanti L. Surgical ventricular restoration: left ventricular shape influence on cardiac function, clinical status, and survival. Ann Thorac Surg 2009; 87:455-61. [PMID: 19161759 DOI: 10.1016/j.athoracsur.2008.10.071] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 10/15/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Myocardial infarction can result in a spectrum of left ventricular (LV) shape abnormalities. Surgical ventricular restoration (SVR) can be applied to any, but there are no data that relate its effectiveness to LV shape. Moreover, there is no consensus on the benefit of SVR in patients with a markedly dilated ventricle, without clear demarcation between scarred and normal tissue. This study describes postmyocardial infarction shape abnormalities and cardiac function, clinical status, and survival in patients undergoing SVR. METHODS Echo studies of 178 patients were retrospectively reviewed. Three types of LV shape abnormalities were identified: type 1 (true aneurysm), type 2 (nonaneurysmal lesions defined as intermediate cardiomyopathy), and type 3 (ischemic dilated cardiomyopathy). RESULTS SVR induced significant improvement in cardiac and clinical status in all patients, regardless LV shape types. Although not significant, mortality was higher in types 2 and 3. CONCLUSIONS Ischemic dilated cardiomyopathy and not just the true aneurysm can be successfully treated with SVR. Shape classification may be useful to improve patient selection and compare results from different institutions that are otherwise impossible to compare.
Collapse
Affiliation(s)
- Marisa Di Donato
- Department of Critical Care Medicine, University of Florence, Florence, Italy.
| | | | | | | | | | | | | |
Collapse
|
48
|
Castelvecchio S, Menicanti L, Ranucci M, Di Donato M. Impact of surgical ventricular restoration on diastolic function: implications of shape and residual ventricular size. Ann Thorac Surg 2009; 86:1849-54. [PMID: 19021992 DOI: 10.1016/j.athoracsur.2008.08.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 08/04/2008] [Accepted: 08/04/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND Limited data are available on left ventricle (LV) diastolic function in patients with ischemic dilated cardiomyopathy submitted to surgical ventricular restoration (SVR). The purpose of this study was to assess postoperative diastolic function changes and identify potential predictors of its worsening. METHODS One hundred and forty-six patients (65 +/- 9 years) with previous anterior myocardial infarction were evaluated before and after SVR. Hemodynamic and geometric parameters including the sphericity index and conicity index were measured. Diastolic function was explored using the transmitral flow velocity pattern, and four classes were defined: normal, abnormal relaxation, pseudonormal, and restrictive pattern. Diastolic function was defined as unchanged (no difference in diastolic pattern), improved (at least one class less), or worsened (at least one class more or, in the case of preoperative restrictive pattern, an early transmitral flow velocity to atrial flow velocity [E/A] ratio increase of at least 20%). RESULTS The filling pattern before SVR was normal in 7 patients (4.8%), abnormal relaxation in 99 (68%), pseudonormal in 28 (19%), and restrictive in 12 (8.2%). After SVR, the filling pattern was unchanged in 105 patients (72%), improved in 14 (9.6%), and worsened in 27 (18.4%). Based on the univariate analysis, the preoperative conicity index and the end-diastolic volume difference (the result of surgical volume reduction) were associated with a diastolic pattern worsening. CONCLUSIONS Diastolic function did not change or improve in the majority of patients. In the minority of patients who experienced worsening, this was associated with the preoperative LV shape and residual volume.
Collapse
|
49
|
Zhong L, Su Y, Yeo SY, Tan RS, Ghista DN, Kassab G. Left ventricular regional wall curvedness and wall stress in patients with ischemic dilated cardiomyopathy. Am J Physiol Heart Circ Physiol 2009; 296:H573-84. [PMID: 19122166 DOI: 10.1152/ajpheart.00525.2008] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Geometric remodeling of the left ventricle (LV) after myocardial infarction is associated with changes in myocardial wall stress. The objective of this study was to determine the regional curvatures and wall stress based on three-dimensional (3-D) reconstructions of the LV using MRI. Ten patients with ischemic dilated cardiomyopathy (IDCM) and 10 normal subjects underwent MRI scan. The IDCM patients also underwent delayed gadolinium-enhancement imaging to delineate the extent of myocardial infarct. Regional curvedness, local radii of curvature, and wall thickness were calculated. The percent curvedness change between end diastole and end systole was also calculated. In normal heart, a short- and long-axis two-dimensional analysis showed a 41 +/- 11% and 45 +/- 12% increase of the mean of peak systolic wall stress between basal and apical sections, respectively. However, 3-D analysis showed no significant difference in peak systolic wall stress from basal and apical sections (P = 0.298, ANOVA). LV shape differed between IDCM patients and normal subjects in several ways: LV shape was more spherical (sphericity index = 0.62 +/- 0.08 vs. 0.52 +/- 0.06, P < 0.05), curvedness at end diastole (mean for 16 segments = 0.034 +/- 0.0056 vs. 0.040 +/- 0.0071 mm(-1), P < 0.001) and end systole (mean for 16 segments = 0.037 +/- 0.0068 vs. 0.067 +/- 0.020 mm(-1), P < 0.001) was affected by infarction, and peak systolic wall stress was significantly increased at each segment in IDCM patients. The 3-D quantification of regional wall stress by cardiac MRI provides more precise evaluation of cardiac mechanics. Identification of regional curvedness and wall stresses helps delineate the mechanisms of LV remodeling in IDCM and may help guide therapeutic LV restoration.
Collapse
Affiliation(s)
- Liang Zhong
- Deparment of Cardiology, National Heart Centre, Singapore
| | | | | | | | | | | |
Collapse
|
50
|
Affiliation(s)
- Marisa Di Donato
- Department of Cardiac Surgery, IRCCS San Donato Hospital
- Department of Critical Care Medicine, University of Florence
| | | | | |
Collapse
|