Left Ventricular Aneurysm: A New Surgical Approach

Abstract

Since 1984, we have used a circular patch to reconstruct the left ventricle ("endoventricular circular plasty") in order to maintain a more physiologic cavity. This technique has three theoretical advantages over standard linear closure of the left ventricle (LV). First, it allows exclusion of the septal akinetic segment of the LV. Secondly, circular reorganization of the remaining LV muscle avoids the restraint caused by the linear suture closure and achieves a more physiologic LV cavity. Thirdly, circular plasty using the patch allows a complete resection of aneurysmal segments including resection of extensive subendocardial scar tissue, when appropriate, without critically compromising the cavity size. The technique involves the following steps: --Resection of dyskinetic or akinetic LV free wall and thrombectomy when indicated. --A dacron patch lined with pericardium is secured at the junction of the endocardial muscle and scarred tissue, thereby excluding non contractile portions of the LV and septum. --Myocardial revascularization is performed as indicated with particular attention paid to revascularizing the proximal left anterior descending segment. The group of patients forming this study includes 130 cases of LV reconstruction since 1984. The three main indications for surgery were angina (40%), cardiac failure (35%), arrhythmias (10%). There have been 8 hospital deaths, 4 late mortalities related to recurrence of cardiac failure in this group.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical Ventricular Restoration for Ischemic Cardiomyopathy with Functional Mitral Regurgitation

“…a. Modified endoventricular circular patch plasty (EVCPP) The presence of an antero-septo-apical akinetic region is a good indication for EVCPP, as reported by Dor and coworkers 29) . At first, coronary revascularization was completely performed under blood cardioplegic cardiac arrest.…”

“…At the end of the 1970s, SVR with patchplasty had been reported for the posterior and anterior regions of the LV 27,28) . In 1980s, Dor and associates established a new surgical technique with a circular patch (endoventricular circular patch plasty; EVCCP) for antero-septo-apical aneurysms 29) . Around the same time, Cooley reported ventricular endoaneurysmorrhaphy with an elliptical patch to allow prompt recovery and restoration of ventricular function 30) .…”

Delayed closure of postinfarction ventricular septum defect in a patient with single vessel disease

“…The concept presented is that of preservation of left ventricular function that provides the groundwork for evolution in the surgical approach to postinfarction VSD. This technique for a ventricular septal rupture repair is a modification of Dor's technique of ventricular endoaneurysmorrhaphy [11].…”

Cardiac CT for Assessment of Myocardial Geometry before and after Surgical Repair of Apical Left Ventricular Aneurysm

“…These patients can undergo surgical repair of the ventricle [6] . LV reconstruction according to Dor has become the established surgical approach [7] and aims at restoring the normal elliptical configuration of the ventricle. This in turn will normalize ventricular volume loading, thereby preventing remodeling and reducing wall tension.…”