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Updated: Nov 6, 2025
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
[Endoventricular Stepwise Plication for Left Ventricular Aneurysm]
Noriyuki Tokunaga1, Tatsuya Watanabe, Kensuke Kondo
1Department of Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan.
Insights
This study details a novel surgical technique for left ventricular (LV) aneurysm repair, successfully removing thrombus and reconstructing the LV shape. The procedure improved LV volume and function, offering a new therapeutic option for patients with LV aneurysms.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Devices
Background:
- Left ventricular (LV) aneurysm is a serious condition often associated with heart failure and thromboembolic events.
- Surgical intervention for LV aneurysm aims to remove thrombus and restore normal cardiac geometry and function.
- Traditional surgical approaches may have limitations in achieving optimal LV reconstruction.
Observation:
- A 69-year-old male patient presented with a left ventricular aneurysm and mobile thrombus, despite oral anticoagulation.
- Echocardiography revealed significant LV dilation (LVEDVI 76 ml/m2, LVESVI 44 ml/m2) and apical dyskinesis.
- Surgical intervention involved opening the LV apex, removing the thrombus, and reconstructing the ventricle with a neo-apex using circular suturing.
Findings:
- The surgical procedure successfully removed the LV thrombus and reconstructed the LV apex.
- Postoperative echocardiography demonstrated a normalized LV shape with reduced volumes (LVEDVI 62 ml/m2, LVESVI 27 ml/m2).
- The patient experienced improved LV function following the neo-apex reconstruction.
Implications:
- This surgical technique offers a promising method for treating LV aneurysms with apical thrombus.
- LV reconstruction using a neo-apex may improve cardiac function and reduce the risk of future embolic events.
- Further studies are warranted to evaluate the long-term efficacy and broader applicability of this surgical approach.
Abstract:
A 69-year-old man was treated with oral anticoagulation for the left ventricular (LV) aneurysm. Echocardiography revealed dyskinetic apex with a mobile thrombus. The estimated LV end-diastolic and end-systolic volume index (LVEDVI, LVESVI) was 76 and 44 ml/m2, respectively. After the LV was opened at the apex parallel to the left anterior descending artery, removal of LV thrombus was performed. LV volume was 70 ml, and diameter of LV aneurysm was 3 cm. After setting a neo-apex, the boundary between the normal and aneurysmal scar tissue were doubly encircled by a pledgeted 2-0 polypropylene suture, and preserved the same diameter as the "aneurysmal neck" (3 cm) in order to secure the minimal residual LV volume. Similarly, second and third circular stitches were placed toward the neo-apex to make the ventricle into an elliptical shape. A postoperative echocardiography showed a well-reconstructed physiologic shape, LV volume( LVEDVI 62 ml/m2, LVESVI 27 ml/m2), and improved LV function.
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