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[Hemodynamic study of postinfarct left ventricular aneurysm]
Insights
Cardiac aneurysm size impacts left-ventricular function and surgical risk. Aneurysms over 25% of ventricular surface show pathological changes, with high surgical risk above 60%.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Context:
- Cardiac aneurysms significantly affect left-ventricular function.
- Assessing aneurysm size and location is crucial for surgical decision-making.
- Traditional left-ventricular function parameters may be limited in aneurysm patients.
Purpose:
- To determine the effect of cardiac aneurysm size and localization on left-ventricular function.
- To establish indications for surgical treatment based on aneurysm characteristics.
- To evaluate the significance of local myocardial kinetics in cardiac aneurysm.
Summary:
- Thirty-five patients with anterior and posterior cardiac aneurysms underwent comprehensive hemodynamic, angiocardiographic, and coronarographic examination.
- Cardiac function is pathologically altered in aneurysms exceeding 25% of ventricular surface area, with high surgical risk above 60%.
- Local kinetics, particularly percentage contraction of cardiac axes, are highly significant for assessing residual myocardium and aneurysm status.
Impact:
- Identifies critical aneurysm size thresholds impacting left-ventricular function and surgical risk.
- Highlights limitations of standard left-ventricular function parameters in cardiac aneurysm.
- Proposes critical parameter values to guide surgical contraindications and high-risk cases.
Abstract:
With a view to the determination of the effect of the size and localization of cardiac aneurysm upon left-ventricular function and the indications for surgical treatment--35 patients with aneurysms of anterior and posterior walls were complexly examined--hemodynamically, angiocardiographically and coronarographically. A method was applied for the determination of the area of anterior aneurysms. The hemodynamics and cardiac functions were established to be pathologically changed in cardiac aneurysm with an area over 25% of the ventricular surface, with a quickly growing risk for surgical treatment with a surface over 60%. The gravest changes were established in case of anterior aneurysms. The possibilities of faults are discussed as well as of the limited significance of the generally accepted parameters of left ventricular function--end diastolic pressure, end diastolic volume, expulsion fraction and the mean velocity of circumferential contraction along the equatorial plane--in the patients with cardiac aneurysm. The high significance of the changes in the local kinetics is confirmed (percentage contraction of the three main axes and their six semi-axes), both for the residual myocardium and aneurysm. Critical values for the parameters applied are proposed, when the surgical treatment is contraindicated or is with a high risk.