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[Left ventricular aneurysms. Hemodynamic studies and surgical results]
Insights
Surgical resection of ventricular aneurysms improved heart function and arrhythmias in most patients. Good outcomes were linked to preserved ejection fraction, smaller akinetic zones, and less coronary artery obstruction.
Area of Science:
- Cardiovascular Surgery
- Cardiac Imaging
- Interventional Cardiology
Context:
- Ventricular dyskinesia, often resulting from myocardial infarction, presents significant challenges in cardiac function.
- Aneurysmal dilation of the ventricle can lead to heart failure and ventricular arrhythmias.
- Surgical intervention is considered for refractory cases, but outcomes can be variable.
Purpose:
- To evaluate the cardiac function and surgical outcomes in patients with ventricular dyskinesia.
- To identify predictors of successful surgical intervention for ventricular aneurysms.
- To assess the impact of aneurysm resection on heart failure and arrhythmias.
Summary:
- This study analyzed 37 patients with ventricular dyskinesia who underwent aneurysm resection.
- Cardiac function was assessed using cineangiography, evaluating contraction amplitude, speed, and akinetic zone volume.
- Coronary artery obstruction was scored, and surgical outcomes were correlated with pre-operative parameters.
Impact:
- Aneurysm resection, particularly with aorto-coronary bypass grafting, significantly improved heart failure symptoms and reduced ventricular arrhythmias.
- Positive surgical outcomes were associated with an ejection fraction >0.40, dyskinetic area <40%, and coronary obstruction index <6.
- The findings provide valuable criteria for patient selection and surgical planning in ventricular aneurysm treatment.
Abstract:
The cardiac function of 37 cases of ventricular dyskinesia were studied by cineangiography. The amplitude and speed of contraction of the contracting parts was evaluated as well as the volume of the akinetic zone. A score of coronary artery obstruction was made for those patients who underwent coronary arteriography. All the patients had resection of their aneurysm. Four patients died in the immediate post-operative period. Six patients developed a temporary low output state requiring circulatory assistance. Twenty-seven patients were operated on successfully without posing any haemodynamic problem. Good immediate and late post-operative results were associated with an ejection fraction of the contracting part greated than 0,40, a dyskinetic area less than 40% and a coronary artery obstruction index of less than 6. Resection of the aneurysm, sometimes associated with aorto-coronary bypass grafting (5 cases), led to a marked improvement in heart failure and/or disappearance of ventricular arrhythmias.