Effect of aneurysmectomy on left ventricular shape and function: case studies

The three dimensional (3D) conformational changes in three patients with large anterior aneurysm in the left ventricle (LV) were examined before and two years after aneurysmectomy by using 3D Cine-computerized tomography (CT). Endocardial and epicardial tracings of 6-9 short axis images encompassing the entire LV were used to reconstruct the LV in 3D. Thickness and percent thickening were calculated using our 3D-volume element approach. A regional wall stress index (stress/pressure) was calculated from regional curvature and thickness. The analysis showed that following resection of the aneurysm the end-diastolic volume was reduced from 257+/-39 to 183+/-39 ml, end-systolic volume from 172+/-39 to 92+/-46 ml and, ejection fraction increased from 34+/-7 to 51+/-13%. The endocardial aneurysm area decreased from 19.7+/-15.9 to 10.1+/-6.5 cm2, whereas the normal zone area was minimally reduced from 87.4+/-17.6 to 79.8+/-10.8 cm2. The percent thickening of the normal zone increased significantly. It is documented here for the first time by detailed 3D analysis that the resection of the LV aneurysm reduces the aneurysmal area and LV size and improves the global and regional function of the remote normal zone. Therefore, the 3D approach can help to design better surgical technique for this complex operation.