A Variant Technique for the Surgical Treatment of Left Ventricular Aneurysms

Abstract

ObjectiveTo present a surgical variant technique to repair left ventricular aneurysms.MethodsAfter anesthesia, cardiopulmonary bypass, and myocardial protection with hyperkalemic tepic blood cardioplegia: 1) The left ventricle is opened through the infarct and an endocardial encircling suture is placed at the transitional zone between the scarred and normal tissue; 2) Next, the scar tissue is circumferentially plicated with deep stitches using the same suture thread, taking care to eliminate the entire septal scar; 3) Then, a second encircling suture is placed, completing the occlusion of the aneurysm, and; 4) Finally, the remaining scar tissue is oversewn with an invaginating suture, to ensure hemostasis. Myocardium revascularization is performed after correction of the left ventricle aneurysm. The same surgeon performed all the operations.ResultsRegarding the post-surgical outcome 4 patients (40%) had surgery 8 eight years ago, 2 patients (20%) were operated on over 6 years ago, and 1 patient (10%) was operated on more than 5 years ago. Three patients (30%) were in functional class I, class II in 2 patients (20%) and 2 patients (20%) with severe comorbidities remains in class III of the NYHA. There were three deaths (at four days, 15 days and eight months) in septuagenarians with acute myocardial infarction, diabetes and pulmonary emphysema.ConclusionThe technique is easy to perform, safe and it can be an option for the correction of left ventricle aneurysms.

Application of PICCO During Anesthesia of Patients Undergoing Transcatheter Ventricular Isolation Plasty Due to Left Ventricular Aneurysm

“…As an interventional treatment, this procedure can increase the LV ejection volume, change the ventricular structure to restore LV shape, improve cardiac function, and reduce clinical symptoms [Ige 2015] by isolating the infarcted and aneurysmal LV apex from the remainder of the cavity [Dhakal 2017]. Anesthesia plays an important role throughout the procedure [Evora 2014]. Pulse index Continuous Cardiac Output (PICCO) during anesthesia enables immediate monitoring of intraoperative hemodynamics and other parameters, thereby providing effective guidance for the anesthetic procedure [Boyle 2007].…”

Application of Circular Patch Plasty (Dor Procedure) or Linear Repair Techniques in the Treatment of Left Ventricular Aneurysms

“…While they can occur immediately after acute myocardial infarction, they can also arise weeks or months later and are frequently seen in the anteroapical, apical and septal regions. Aneurysms occur in 3.5 to 38% of the cases due to insufficient replacement of necrotic myocardial tissue after acute transmural myocardial infarction with scar tissue in about six weeks [ 1 - 4 ] . Aneurysm disrupts the normal ellipsoid geometrical structure of the left ventricle (LV), leading to a dilated spherical ventricle with limited contractility and filling capacity [ 5 - 7 ] .…”

Post-Infarction Left Ventricular Aneurysm Repair

“…This situation inspired doctor Adib Jatene on his revolutionary concept of "geometrical reconstruction of the left ventricle" to treat aneurysms of this cardiac chamber, which is one of most important contribution of the Brazilian cardiac surgery [2] . Based on this concept we proposed a surgical variant technique to repair left ventricular aneurysms (Figure 1) [3,4] .…”

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Fig. 1A) First endocardial encircling suture around the transitional zone between the scarred and normal tissue; B) Scar tissue plication using the same suture thread (this surgical maneuver keeps the aneurysm neck occluded, preserving the pyriform left ventricle shape); C) Second encircling suture is tightened, completing the aneurysm occlusion; D) The remaining scar tissue is oversewn with a running “out-out” suture, to ensure hemostasis [3] .

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“…It is relevant to mention that there are, beside experiences around the world, convincing experiences for ventricular reconstruction: 1) Direct suture; 2) Modification of the Cooley technique with patch suture; 3) Dor patch plasty with septal exclusion [5] ; 4) Jatene geometric reconstruction with semi-rigid bovine pericardial prosthesis, and 5) Attempts to compare different techniques without definitive proof of superiority among them. However, from safety and reduction of surgical time, the "no patch" surgical variants techniques would be useful for the decision whether to operate left ventricular aneurysm or akinesia [3,5] .…”