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[The effect of aneurysm resection on left ventricular function]
Insights
Successful aortocoronary bypass surgery significantly improved left ventricular (LV) function in patients with coronary-artery disease and ventricular aneurysm. Post-surgery, patients showed enhanced ejection fraction and improved ventricular wall motion.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) often leads to left ventricular (LV) dysfunction and aneurysm formation.
- Surgical intervention, including aortocoronary bypass grafting (ACBG) and ventricular aneurysm resection, aims to restore cardiac function.
- Assessing the impact of these combined surgical procedures on LV mechanics is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the effect of successful ACBG and ventricular aneurysm resection on LV function in patients with CAD.
- To quantify changes in LV volumes, ejection fraction, and regional wall motion post-surgery.
Main Methods:
- Retrospective analysis of 13 patients with CAD and ventricular aneurysm undergoing ACBG and aneurysmectomy.
- Left ventricular cine-angiography (single-plane, right anterior oblique) performed pre- and post-operatively.
- Calculation of LV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI), ejection fraction (EF), and regional wall motion parameters (SMV, SMH, SMS).
Main Results:
- Significant improvements observed 11 months post-surgery compared to baseline (4 months pre-op).
- Mean EF increased from 32.6% to 54.6%.
- Significant improvements in LV end-diastolic volume index (154 to 126 ml/m2), end-systolic volume index (107 to 56 ml/m2), and stroke volume index (46.5 to 69.9 ml/m2).
- Marked enhancement in anterior wall motion (SMV: 6.1% to 25.0%) and apical motion (SMS: 5.1% to 13.1%).
Conclusions:
- Aortocoronary bypass surgery combined with ventricular aneurysm resection leads to substantial improvement in left ventricular function.
- The surgical approach effectively enhances global and regional ventricular contractility in patients with severe cardiac failure due to CAD and aneurysm.
Abstract:
The effect of successful aortocoronary artery bypass surgery on left ventricular (LV) function was studied by angiography in 13 patients with coronary-artery disease and resection of a ventricular aneurysm. The following were calculated from single-plane right anterior oblique LV cine-angiograms: LV end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), percentage shortening of the medial perpendicular short axis (deltaM), mean velocity shortening of the circumferential fibres (VCF). The changes in the five hemi-axes of the anterior LV wall, and five of the inferior wall were averaged to give a value for relative anterior wall motion (SMV) and inferior wall motion (SMH). Changes in apical motion (SMS) were calculated from the percentage changes in the base-to-apex axis. The following mean values (x plus or minus s) were obtained four months before and 11 months after aneurysmectomy: EDVI (ml/m2) 154 plus or minus 27 (126 plus or minus 23), ESVI (ml/m2) 107 plus or minus 28 (56 plus or minus 15), SVI (ML/M2) 46.5 plus or minus 12.7 (69.9 plus or minus 23.1), EF (%) 32.6 plus or minus 8.0 (54.6 plus or minus 12.0), SMV (%) 6.1 plus or minus 10.0 (25.0 plus or minus 13.4), SMH (%) 25.9 plus or minus 13.1 (31.2 plus or minus 11.1), SMS (%) 5.1 PLus or minus 3.4 (13.1 plus or minus 4.2). These results indicated significant improvement in ventricular pumping action and wall motion after aneurysm resection and aortacoronary bypass surgery in patients with coronary-artery disease and severe cardiac failure.