Atypical myocardial delayed enhancement after surgical ventricle restoration

To retrospectively evaluate delayed enhancement after surgical ventricle restoration (SVR).

Thirty patients with post-ischemic akinetic dilatation underwent cine and gadobenate dimeglumine-enhanced MRI before and 2-6 months after SVR. End-diastolic volume (EDV) normalized to body surface area (EDV index, EDVI), end-systolic volume index (ESVI), and ejection fraction (EF) of the left ventricle were obtained. Delayed enhancement involving subendocardial myocardium was considered typical (TDE) while enhancement apparently not involving subendocardium in its typical location was considered atypical (ADE). Wilcoxon signed-rank, Mann-Whitney U, and χ2 tests were used.

All 30 patients showed TDE prior to surgery but 16 of them (53%) showed ADE after SVR. Before SVR, EDVI (ml/m2) was 171±101 in patients with ADE and 127±41 in patients with TDE, ESVI (ml/m2) was 130±105 and 94±36, EF was 25±6% and 24±9%, respectively, without significant differences (P>0.347). After SVR, EDVI (ml/m2) was 99±24 and 89±28 (P=0.275), ESVI (ml/m2) 66±24 and 65±30, respectively, without significant differences (P>0.275) while EF was 37±12% and 29±13%, respectively, with a near-significant difference (P=0.077). The increase in EF before/after SVR was significant only for patients with ADE (P=0.006). Of 20 patients in whom a patch had been used for SVR, 14 showed ADE and 6 TDE; of 10 patients without patch, 2 and 8, respectively (P=0.010).

ADE was found in about half of SVR patients and was associated with the use of patch and EF improvement.