Septal reshaping

Left ventricular (LV) aneurysm is a complication of an acute myocardial infarction (AMI). Herein a new technique is described that is indicated when the postinfarctual scar involves the septum more than the free wall. The incision starts at the apex and is directed, parallel to LAD, toward the base of the heart. The septum is rebuilt using 1 or 2 U-stitches, passed from inside, to join the anterior wall to the septum. The starting point begins as high as the scar, maintaining an oblique direction toward the new apex. An oval dacron patch is then sutured from the septum (end of the direct suture through the border with the inferior septum) to the anterior wall (between the healthy and the scarred wall) up to the new apex. Thirty-day mortality is low. This procedure provides good midterm results. New York Heart Association class improved from 2.7±0.9 to 1.6±0.5 (P≪0.001). Left ventricle (end-diastolic and end-systolic) volume, reduced significantly. Stroke volume normalized and ejection fraction increased even if not significantly. Mitral regurgitation reduced significantly from 2.5 to 0.6. No new mitral regurgitation developed.