A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle

Optimization of surgical ventricular restoration by in-silico simulations

OBJECTIVE

A hypothesis on left ventricular aneurysms states that there is better preservation of contractile myocardium when the aneurysm geometry is rectangular as opposed to circular. Pre-surgical planning of surgical ventricular restoration was performed on the basis of this hypothesis.

METHODS

The intraventricular patch used to exclude scarred or aneurysmal myocardium remains akinetic, hence it was used to define aneurysm geometry as circular or rectangular. Hausdorff distance analysis was carried out by mathematical computational methods on the baseline cardiac magnetic resonance images of 5 patients.

RESULTS

The mean Hausdorff distance for the full range of frequencies was significantly greater after endoventricular linear patch plasty (0.474 ± 0.190 vs. 0.722 ± 0.221 mm, p = 0.047), whereas after endoventricular circular patch plasty, the difference was not significant (0.474 ± 0.190 vs. 0.594 ± 0.193, p = 0.175). The mean Hausdorff distance <0.5 mm was also significantly greater after endoventricular linear patch plasty than after endoventricular circular patch plasty: 0.258 ± 0.03 mm at baseline vs. 0.40 ± 0.16 mm after linear patch plasty (p = 0.039) and 0.258 ± 0.03 vs. 0.32 ± 0.10 mm (p = 0.130) after circular patch plasty.

CONCLUSIONS

In-silico technology using the Hausdorff distance enables pre-surgical planning and optimization of the technique for surgical ventricular restoration.

Postmyocardial infarction left ventricular dysfunction - assessment and follow up of patients undergoing surgical ventricular restoration by the endoventricular patchplasty

BACKGROUND

Surgical ventricular restoration with endoventricular patchplasty improves left ventricular function and restores left ventricular shape.

METHOD

The study included patients who presented with transmural anterior myocardial infarctions between June 2007 and May 2008. Briefly the technique included - coronary revascularization, resection of the endocardial scar, left ventricular reconstruction using an endoventricular synthetic patch. Left ventricular geometric parameters were studied preoperatively, early postoperatively, at 3 and 6 months and statistically analyzed by SPSS 14 software package.

RESULTS

The ejection fraction increased from 33.5 ± 5.02 to 37.77 ± 7.17 immediate postoperatively. The preoperative left ventricular ejection fraction - a mean of 33.25% (±5.02%), increased by 10.3%-11% at the third and fourth follow up respectively after surgical ventricular restoration (p ≤ 0.001). The left ventricular end systolic volume index improved from a mean of 48.84 ± 11.37 preoperatively to 24.66 ± 5.92 postoperatively (p ≤ 0.001).

CONCLUSIONS

Surgical ventricular restoration in our study has clearly demonstrated a positive effect on LV geometry.