Short-term follow-up of patients after aneurysmectomy of the left ventricle

Silveira, Wilson Luiz da; Leite, Adélio Ferreira; Soares, Érica Coelho Garcia; Nery, Max Weyler; Carneiro, Antônio Fernando; Oliveira, Vilmondes Gonçalves de

doi:10.1590/s0066-782x2000001100004

Cited by 5 publications

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References 26 publications

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“…O tratamento inicial da paciente não incluía antiplaquetários. Está bem demonstrado que o tratamento com antiplaquetários foi benéfi co para pacientes que sofreram infarto do miocárdio e para portadores de cardiopatia isquêmica crônica por aterosclerose coronária 11 .…”

Section: Aspectos Clínicosunclassified

Caso 2/06 - insuficiência cardíaca na evolução tardia depois de infarto do miocárdio em mulher de 33 anos de idade

Mangili¹,

Moffa

Benvenuti

2006

Arq. Bras. Cardiol.

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Mulher de 33 anos de idade procurou atendimento médico em razão de piora da falta de ar há duas semanas.A paciente sofreu, aos 31 anos de idade, infarto do miocárdio. Depois do infarto, evoluiu com dispnéia desencadeada por esforços moderados que progrediu até ser desencadeada por mínimos esforços e ocorrer mesmo em repouso. A paciente era tabagista.O cateterismo cardíaco realizado dois meses após o infarto revelou pressões na aorta 120/80 mmHg e no ventrículo esquerdo (VE) 120/20 mmHg. A cineangiocoronariografi a revelou lesão de 60% na origem do ramo interventricular anterior da artéria coronária esquerda. A ventriculografi a revelou aumento de VE com acinesia ântero-lateral e apical, e insufi ciência mitral moderada.O exame físico no primeiro atendimento no Hospital, há um ano, revelou freqüência cardíaca de 70 bpm, pressão arterial 110/70 mmHg. O exame dos pulmões foi normal. O exame do coração revelou segunda bulha hiperfonética em área pulmonar e sopro sistólico ++/4 em área mitral. O exame do abdome foi normal e não havia edema de membros.O eletrocardiograma de há um ano revelou ritmo sinusal, freqüência 79 bpm, duração de QRS de 129 mseg, SÂQRS -30° para trás, ondas Q em I, aVL, V 3 e V 4 , ondas S profundas em V 2 e V 3 e persistência de supradesnível de segmento ST em derivações precordiais. Os diagnósticos eletrocardiográfi cos foram de sobrecarga atrial esquerda, distúrbio intraventricular da condução do estímulo do tipo bloqueio de ramo esquerdo, bloqueio da divisão ânterosuperior do ramo esquerdo e áreas eletricamente inativas em paredes lateral e anterior (Fig. 1).A radiografia de tórax revelou aumento da área cardíaca, sem sinais de congestão pulmonar.Os exames laboratoriais naquela ocasião revelaram 12,6 g/dl de hemoglobina, hematócrito 37%, colesterol Fig. 1 -Eletrocardiograma -Sobrecarga atrial esquerda, distúrbio de condução intraventricular do estímulo, bloqueio da divisão ântero-superior do ramo esquerdo e área eletricamente inativa ântero-lateral

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Section: Aspectos Clínicosunclassified

Caso 2/06 - insuficiência cardíaca na evolução tardia depois de infarto do miocárdio em mulher de 33 anos de idade

Mangili¹,

Moffa

Benvenuti

2006

Arq. Bras. Cardiol.

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Surgical approaches to left ventricular reconstruction: a matter of perspective

Doenst

2012

Heart Fail Rev

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Surgical reconstruction of physiological shape and size of a postischemically remodeled left ventricle has been advocated to improve ventricular function and improve patient long-term outcome. What initially started as linear aneurysm resection surgery developed over the years into the endoventricular repair techniques (surgical ventricular reconstruction, SVR) that have also been applied in patients with postischemically dilated ventricles and mainly anterior akinesia. SVR improved function as measured by the ejection fraction. Whether it affects survival was finally tested in the largest surgical trial ever conducted, the STICH trial (Surgical Treatment for IsChemic Heart failure). The trial, however, presented rather sobering information with its Hypothesis 2 outcome by demonstrating identical 5-year survival rates between SVR plus bypass grafting (CABG) and CABG alone. SVR also did not improve quality of life. This neutral finding spawned a series of critical responses with respect to trial design and conduct accompanied by appropriate responses by the trial's leadership. At the end of this dispute, it appears that SVR has been accepted as not very useful for most patients and is less and less performed in daily practice. What remains is a series of different perspectives that will be discussed in this review. The conclusion will be that SVR may be of low value for the patient with dilated and massively remodeled ventricles, but the technique bears therapeutic potential for some patients for different reasons so that the surgeon's ability to perform this operation should not get lost.

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Early and late outcome of left ventricular reconstruction surgery in ischemic heart disease

Klein

Bax

Shaw³

et al. 2008

European Journal of Cardio-Thoracic Surgery

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A systematic review of the literature was performed to determine early and late mortality associated with left ventricular (LV) reconstruction surgery and to assess the influence of different surgical techniques, concomitant surgical procedures, clinical and hemodynamic parameters on mortality. The MEDLINE database (January 1980-January 2005) was searched and from the pooled data, hospital mortality and survival were calculated. Summary estimates of relative risks (RR) were calculated for the techniques that were used and for concomitant coronary artery bypass grafting (CABG) and mitral valve surgery. The risk-adjusted relationships between mortality and clinical and hemodynamic parameters were assessed by meta-regression. A total of 62 studies (12,331 patients) were identified. Weighted average early mortality was 6.9%. Cumulative 1-year, 5-year and 10-year survival were 88.5%, 71.5% and 53.9%, respectively. Endoventricular reconstruction (EVR) showed a reduced risk for both early (RR=0.79, p<0.005) and late (RR=0.67, p<0.001) mortality compared to the linear repair (early: RR=1.38, p<0.001; late: RR=1.83, p<0.001). Early and late mortality were mainly cardiac in origin, with as predominant cause heart failure in respectively 49.7% and 34.5% of the cases. Ventricular arrhythmias caused 16.6% of early deaths and 17.2% of late deaths. Concomitant CABG significantly decreased late mortality (RR=0.28, p<0.001) without increasing early mortality (RR=1.018, p=0.858). Concomitant mitral valve surgery showed both an increased risk for early (RR=1.57, p=0.001) and late mortality (RR=4.28, p<0.001). No clinical or hemodynamic parameters were found to influence mortality. It is noteworthy that only one third of patients included in the current analysis were operated for heart failure (14 studies, 4135 patients). In this group we noted an early mortality of 11.0% with a late mortality (3-year) of 15.2%. This analysis of pooled literature data showed that LV reconstruction surgery is performed with acceptable mortality and EVR may be the preferred technique with a reduced risk for early and late mortality. Concomitant CABG improved outcome, whereas the need for mitral valve surgery appeared an index of gravity. No clinical or hemodynamic parameters were found to influence mortality; specifically LV ejection fraction and LV volumes both did not predict outcome.

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Short-term follow-up of patients after aneurysmectomy of the left ventricle

Abstract: Surgical correction was adequate in the immediate follow-up of operated patients, and mortality was higher in patients with higher functional class.

Cited by 5 publications

References 26 publications

Caso 2/06 - insuficiência cardíaca na evolução tardia depois de infarto do miocárdio em mulher de 33 anos de idade

Caso 2/06 - insuficiência cardíaca na evolução tardia depois de infarto do miocárdio em mulher de 33 anos de idade

Surgical approaches to left ventricular reconstruction: a matter of perspective

Early and late outcome of left ventricular reconstruction surgery in ischemic heart disease

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