Left ventricular function after elective aneurysmectomy

Lumia, Frank J.; Makam, Sashi; MacMillan, Robert M.; Germon, Patricia A.; Maranhão, Vladir; Strong, Michael D.

doi:10.1002/clc.4960080703

Cited by 12 publications

(4 citation statements)

References 17 publications

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“…The mortality rate was significantly higher for patients with LVA [1][2][3][4] owing to a higher incidence of complications such as ventricular arrhythmias, 23 thromboembolic phenomena, 24 and congestive heart failure. 25 Moreover, Meizlish et al 26 reported that LVA carries a high risk of mortality independent of left ventricular ejection fraction. Therefore, it is reasonable to predict which patients will have LVA after acute MI, and HRV analysis on day 5 may help the clinician to define the patients with a high risk for developing LVA.…”

Section: Discussionmentioning

confidence: 99%

Sympathetic Overactivity in Patients With Left Ventricular Aneurysm in Early Period After Anterior Myocardial Infarction: Does Sympathetic Activity Predict Aneurysm Formation?

et al. 2007

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Left ventricular aneurysm (LVA) is an important complication of acute transmural myocardial infarction (MI) that bears great clinical significance because of high mortality. Heart rate variability (HRV) analysis is extensively used to evaluate autonomic modulation of sinus node and to identify patients at risk for an increased cardiac mortality. In this study, the authors evaluated HRV in patients with LVA in the early period after acute anterior wall MI. They compared 18 patients (7 men, 11 women, with an average age of 56.1 +/-8.2 years) with LVA and 46 patients (34 men, 12 women, with an average age of 56.4 +/-5.9 years) without LVA. Mean heart rate, low frequency (LF) and low-frequency/high-frequency (LF/HF) ratio were significantly higher and standard deviation of normal-to-normal RR intervals (SDNN), root mean square of successive differences (RMSSD), number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50), and HF were lower in the patients with LVA. A SDNN <78 ms separated the patients with aneurysm from those without aneurysm with a sensitivity of 78%, specificity of 83%, positive predictive accuracy of 79%; a LF/HF ratio >2.4 with a sensitivity of 92%, specificity of 88%, and positive predictive accuracy of 92%. Single-vessel disease increased the left ventricular aneurysm formation by 5.1 fold, total left anterior descending artery (LAD) occlusion by 3.1 fold, mean heart rate >75 beats/minute by 2.3 fold, SDNN <78 ms by 7.9 fold, and LF/HF ratio >2.4 by 12.9 fold, but well-developed collaterals decreased the aneurysm formation by 4.4 fold. As a result, HRV analysis supplies parameters with high predictive value for LVA formation in the early period after acute anterior MI. The higher sympathetic activity and reduced heart rate variability may be associated with a higher incidence of complications such as ventricular arrhythmias and increased mortality in patients with LVA.

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Section: Discussionmentioning

confidence: 99%

Sympathetic Overactivity in Patients With Left Ventricular Aneurysm in Early Period After Anterior Myocardial Infarction: Does Sympathetic Activity Predict Aneurysm Formation?

et al. 2007

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“…Unlike patients with ischemic cardiomyopathy and congestive heart failure in whom bypass graft surgery is not helpful,59 the presence of LVA in a patient with severe congestive heart failure is an indication for surgery. 60,61 Contrast ventriculography and other noninvasive methods can help differentiate between the two entities in the patient with coronary artery disease and congestive heart failure. These tests can also help predict operative risk and improvement in functional class.…”

Section: Congestive Heart Failurementioning

confidence: 99%

Left ventricular aneurysm: A review

Ba'albaki

Clements

1989

Clinical Cardiology

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Summary:The vast majority of left ventricular aneurysms (LVA) are secondary to coronary artery disease. The natural history of LVA is now better understood. The increasing use of noninvasive techniques has allowed earlier recognition and better appreciation of LVA genesis and pathophysiology . Improvements in surgical anesthesia and techniques have resulted in more successful LVA surgery. This article reviews the pathogenesis, natural history, and complications of LVA. Surgical indications and available treatment options in the management of patients with LVA and severe symptoms are presented. Left ventricular pseudoaneurysm (false aneurysm) will also be discussed.Key words: noninvasive techniques, ventricular amhythmias, congestive heart failure, endocardial resection, left ventricular aneurysmectomy DefinitionsThe marked variability in the definition of LVA is partly responsible for difficulties encountered in studying different reports regarding the natural history and treatment of the entity. Definitions vary across different disciplines and technologies. To the pathologist, LVA usually refers to a thin and stretched area of the ventricle where mature scar tissue has replaced most of the myocardium. T o the physiologist and clinician, LVA is best defined as a portion of the ventricle that manifests systolic expansion ir- respective of histologic structure. The surgeon's definition essentially agrees with the pathologist's.For the purpose of this discussion, LVA is defined as a localized protrusion of the left ventricular (LV) cavity during systole and diastole with akinetic or dyskinetic walls. EtiologyLeft ventricular aneurysm most commonly results from acute myocardial infarction (MI). An incidence varying from 3.5 to 5% has been reported in autopsy studies.',2 Angiographically defined LVA has been reported in 7.6% of patients with coronary arteIy disease referred for coronary angi~graphy.~ On the other hand, in selected patients undergoing radionuclide angiography soon after MI, 35 % had LVA.4 Greater than 80% of left ventricular aneurysms involve the anterior wall and/or apex and are associated with high-grade stenosis or complete occlusion of the proximal or mid-left anterior descending coronary artery (LAD).3-5 The presence of only three muscle layers at the apex (compared with four layers at the base) explains the predeliction of the apex to LVA formation. Myocardial infarction is usually transmural and is associated with high peak levels of the enzyme creatine k i n a~e .~.~ Approximately 50% of left ventricular aneurysms occumng after acute MI appear within 48 h from the onset of chest pain. The remainder appear within two weeks.4 Once formed, LVA rarely resolves. Myocardial infarction and LVA may result from coronary arterial emboli or anomalous origin of the left coronary artery from the pulmonary artery.Not all patients with coronary atherosclerosis have scar tissue in the area of LVA. Transient occlusion of a coronary artery may result in reversible dyskinesis (physiologic LVA).' Patients with i...

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“…Left ventricular aneurysm (LVA) secondary to acute myocardial infarction (AMI) can lead to a poor prognosis. Heart failure [1] is the most common cause of death in patients with LVA duo to severe left ventricle (LV) remodeling. Surgical repair is still the optimal therapy for LVA.…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Aneurysm Repair: Off-pump Linear Plication versus On-pump Patch Plasty

Hua

Chai

Liu

et al. 2019

Braz J Cardiovasc Surg

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Objective The study aimed to compare the clinical outcomes of simplified linear plication and classic patch plasty in patients with left ventricular aneurysm (LVA). Methods We retrospectively reviewed 282 patients undergoing LVA repair between 2006 and 2016. After propensity score matching, 45 pairs of patients receiving LVA surgery were divided into either a patch group (on-pump endoventricular patch plasty) or a plication group (off-pump linear plication). Then, their early surgical outcomes and long-term survival were compared in two matched groups. Results The heart function improvement at discharge was similar in the two matched groups, while patients in the patch group more commonly suffered from low cardiac output syndrome ( P =0.042) with higher proportion of intra-aortic balloon pumping assistance ( P =0.034) than patients in the plication group. Compared with patients in the patch group, the patients in the plication group had shorter recovery times, regarding to mechanical ventilation, intensive care unit stay, and hospital stay ( P <0.001, P <0.001, and P =0.001, respectively). No significant difference was found in the long-term survival ( P =0.62). Conclusions Off-pump linear plication presented acceptable results in terms of early outcomes and long-term survival. For high-risk patients, the simplified LVA repair technique may be an option.

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Left ventricular function after elective aneurysmectomy

Cited by 12 publications

References 17 publications

Sympathetic Overactivity in Patients With Left Ventricular Aneurysm in Early Period After Anterior Myocardial Infarction: Does Sympathetic Activity Predict Aneurysm Formation?

Sympathetic Overactivity in Patients With Left Ventricular Aneurysm in Early Period After Anterior Myocardial Infarction: Does Sympathetic Activity Predict Aneurysm Formation?

Left ventricular aneurysm: A review

Left Ventricular Aneurysm Repair: Off-pump Linear Plication versus On-pump Patch Plasty

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