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[Left ventricular reconstruction in patients with left ventricular aneurysm after myocardial infarction]
Qiang Wang1, Li Xu, Dongjin Wang
1Cardiothoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing Jiangsu 210008, PR China.
Objective:
To discuss left ventricular reconstruction methods and effectiveness in patients with left ventricular aneurysm after myocardial infarction.
Methods:
Between June 2003 and August 2008, 23 patients with left ventricular aneurysm after myocardial infarction were treated. Of them, 13 were male and 10 were female with an average age of 61.2 years (range, 47-74 years). According to New York Heart Association (NYHA) criteria for cardiac function, there were 3 cases of grade I, 6 cases of grade II, 10 cases of grade III, and 4 cases of grade IV. The coronary arteriography showed single-vessel disease in 2 cases, double-vessel disease in 5 cases, triple-vessel disease in 16 cases. The locations of ventricular aneurysm were the apex cordis in 18 cases, antetheca and parieslateralis in 4 cases, and interior wall in 1 case. The left ventricular ejection fraction was 36.52% +/- 12.15%, and left ventricular diastolic final diameter was (62.30 +/- 6.52 ) mm. Nine patients received standard linear repair, 6 patients received standard linear repair after endocardial ring shrinkage, and 8 patients received patch suture after endocardial ring shrinkage.
Results:
Two cases died perioperatively, and re-thoracotomy was performed to stop bleeding in 1 case. Incisions healed by first intention in the other patients without early complication. Twenty-one patients were followed up 7-48 months (median, 19 months). At 6 months after surgery, the left ventricular ejection fraction 46.52% +/- 9.41% were significantly improved when compared with that at preoperation (t = 2.240, P = 0.023); the left ventricular diastolic final diameter (52.23 +/- 5.11) mm were significantly decreased when compared with that at preoperation (t = 2.170, P = 0.035). The cardiac function according to NYHA criteria was at grade I in 8 cases and at grade II in 13 cases. One patient died of cerebral hemorrhage at 18 months after operation and the activities of daily living recoverd in the others.
Conclusion:
Individual therapeutic methods are used according to patients' different conditions for left ventricular aneurysm after myocardial infarction.
