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Severe diastolic dysfunction after endoventriculoplasty
1Division of Thoracic and Cardiovascular Surgery, L. Sacco Hospital, Milan, Italy.
Insights
Endoventriculoplasty may worsen diastolic function, leading to a restrictive filling pattern in 8% of patients. This pattern predicts poor outcomes and necessitates caution in severely ill patients, particularly those with recent myocardial infarction.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Endoventriculoplasty with pericardial patch is used for anteroseptal ventricular aneurysm repair.
- Limited data exists on its impact on diastolic left ventricular function.
Purpose of the Study:
- To evaluate changes in diastolic left ventricular function after endoventriculoplasty.
- To assess the influence of pulsed Doppler transmitral flow patterns on patient outcomes.
Main Methods:
- Pulsed Doppler echocardiography was used to record diastolic transmitral flow.
- Spectral analysis identified normal, inverted, and restrictive filling patterns.
- Clinical and hemodynamic parameters were correlated with Doppler findings.
Main Results:
- A significant minority (8%) developed a postoperative restrictive diastolic filling pattern.
- These patients exhibited severe clinical and hemodynamic impairment.
- Postoperative restrictive filling predicted 3-month mortality and treatment challenges.
Conclusions:
- Endoventriculoplasty can adversely affect diastolic function, resulting in a restrictive pattern.
- This pattern is associated with poor prognosis and difficult medical management.
- Caution is advised for endoventriculoplasty in severely ill patients, especially post-myocardial infarction; consider conservative volume reduction.
Abstract:
Endoventriculoplasty with pericardial patch has been advocated to repair anteroseptal ventricular aneurysm, but not studies have reported the influence of this technique on diastolic left ventricular function. We have evaluated the changes on ventricular filling by means of pulsed Doppler recording of diastolic transmitral flow. Doppler analysis reveals three distinct spectral patterns: (1) normal, (2) inverted, and (3) restrictive. We have found an abrupt change from a preoperative normal to postoperative restrictive pattern in a significant minority of patients (8%) who underwent endoventriculoplasty. These patients had clinical and hemodynamic signs (New York Heart Association class, time from anterior myocardial infarction, left ventricular end-diastolic pressure, pulmonary hypertension, and mitral regurgitation) of severe impairment but no differences were found in ejection fraction, aneurysmal extension, or remote myocardial function. Moreover, after operation they had a satisfactory ejection fraction, a low end-diastolic volume, and an apex-base length shorter than the predicted value for a normal population. The presence of a postoperative restrictive pattern of diastolic filling is a strong predictor of 3-month mortality and makes the medical treatment difficult. Caution must be taken to perform endoventriculoplasty in patients who are severely ill, especially those recently affected by myocardial infarction. When the clinical conditions dictate the operation, a nonenthusiastic volume reduction seems to be a prudent option.