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Biventricular pacing with coronary bypass and Dor's ventriculoplasty
Tomohiro Mizuno1, Hiroyuki Tanaka, Satoru Makita
1Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Insights
Biventricular pacing combined with cardiac surgery improved heart function in a patient with severe dilated cardiomyopathy and left bundle branch block. This intervention resynchronized left ventricular contraction and reduced mitral regurgitation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Severe ischemic dilated cardiomyopathy presents significant challenges in cardiac function.
- Complete left bundle branch block further impairs left ventricular contraction and synchrony.
- Combined surgical and device interventions are explored for complex cardiac conditions.
Observation:
- A patient with severe ischemic dilated cardiomyopathy (ejection fraction 19%) and complete left bundle branch block underwent biventricular pacing.
- An epicardial left ventricular lead was implanted during on-pump beating coronary artery bypass grafting and Dor's endoventricular circular patch plasty.
- Immediate effects of biventricular pacing on cardiac mechanics were assessed.
Findings:
- Biventricular pacing rapidly resynchronized left ventricular contraction.
- The intervention led to significant improvements in overall cardiac function.
- A notable reduction in mitral regurgitation was observed post-pacing.
Implications:
- Biventricular pacing combined with cardiac surgery may offer substantial benefits for patients with cardiomyopathy and left bundle branch block.
- This approach can potentially improve left ventricular function and reduce valvular regurgitation.
- Further research is warranted to explore the long-term efficacy and broader applicability of this combined strategy.
Abstract:
We applied biventricular pacing to a patient with severe ischemic dilated cardiomyopathy (left ventricular [LV] ejection fraction 19%, LV end-diastolic volume 360 mL, and complete left bundle branch block). An epicardial LV lead was surgically implanted concomitant with on-pump beating coronary artery bypass grafting and Dor's endoventricular circular patch plasty. Biventricular pacing immediately achieved the resynchronization of the LV contraction, and improved cardiac function as well as reducing mitral regurgitation. Biventricular pacing combined with cardiac surgery for patients with cardiomyopathy and complete left bundle branch block may produce beneficial effects on LV function.