Multislice computed tomography-guided surgical repair of acquired posterior left ventricular aneurysms: demonstration of mitral valve and left ventricular reverse remodelling

Solowjowa, Natalia; Penkalla, Adam; Dandel, Michael; Novikov, A N; Pašić, Miralem; Weng, Yuguo; Falk, Volkmar; Knosalla, Christoph

doi:10.1093/icvts/ivw137

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…Previous studies ( 4 , 22 ) demonstrated that CCT is a valuable tool to evaluate LV and MV geometry and function. In our previous study ( 5 ) we showed that CCT data enable the precise analysis of LV volume, geometry and local WMA as well as the reliable recognition of aneurysm borders, thrombotic apposition and presence of LV pseudoaneurysm. This study focuses on prognostic important volumetric and functional characteristics and on the validation of the CCT-based separation of the aneurysm volume from the residual LV volume and thereby on improvement of the therapy targeting, with the further aim to avoid the restrictive residual LV volume.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Restoration of Antero-Apical Left Ventricular Aneurysms: Cardiac Computed Tomography for Therapy Planning

Solowjowa

Nemchyna

Hrytsyna

et al. 2022

Front. Cardiovasc. Med.

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BackgroundSurgical ventricular restoration (SVR) leads to functional improvement by volume reduction and restoration of left ventricular (LV) geometry. Our purpose was to refine the planning for SVR using cardiac computed tomography (CCT).MethodsThe possibility to anticipate the postoperative residual LV volume was assessed using CCT in 205 patients undergoing SVR combined with coronary artery bypass grafting (77%), mitral valve repair/replacement (19%) and LV thrombectomy (19%). The potential of CCT to guide the procedure was evaluated. Additionally, the predictive value of CCT characteristics on survival was addressed.Results30-day, 1- and 5-year survival was 92.6, 82.7, and 72.1%, respectively, with a marked reduction of NYHA class III-IV quota after surgery (95.1% vs. 20.5% in the follow-up). Both pre- and postoperative LV end-systolic volume index (LVESVI) were predictive of all defined endpoints according to the following tertiles: preoperative: <74 ml/m2, 74–114 ml/m2 and >114 ml/m2; postoperative: <58 ml/m2, 58–82 ml/m2 and >82 ml/m2. On average, a 50 ml/m2 increase of preoperative LVESVI was associated with a 35% higher hazard of death (p = 0.043). Aneurysms limited to seven antero-apical segments (1–7) were associated with a lower death risk (n = 60, HR 0.52, CI 0.28–0.96, p = 0.038). LVESVI predicted by CCT was found to correlate significantly with effectively achieved LVESVI (r = 0.87 and r = 0.88, respectively, p < 0.0001).ConclusionsCCT-guided SVR can be performed with good mid-term survival and significant improvement in HF severity. CCT-based assessment of achievable postoperative LV volume helps estimate the probability of therapeutic success in individual patients.

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Section: Discussionmentioning

confidence: 99%

“…CCT measurements have been extensively described previously ( 5 ). The data were obtained and analyzed in a single lab by use of the uniform protocols.…”

Section: Methodsmentioning

confidence: 99%

Surgical Restoration of Antero-Apical Left Ventricular Aneurysms: Cardiac Computed Tomography for Therapy Planning

Solowjowa

Nemchyna

Hrytsyna

et al. 2022

Front. Cardiovasc. Med.

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“…LVP typically occur in adults following transmural myocardial infarction and less frequently after trauma [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

“…After a median sternotomy was performed, a previous pericardial rupture at the level of the right pulmonary veins was revealed. A pseudoaneurysmectomy was performed, followed by patch-closure (70 × 40 mm) of the aneurysmal neck according to our institutional treatment algorihthm [2]. MV replacement was performed in a standard fashion with preservation of the chordae tendinae in order to maintain the normal geometry of the mitral subvalvular apparatus.…”

Section: Operationmentioning

confidence: 99%

Left Ventricular Pseudoaneurysmectomy and Mitral Valve Replacement 30 Years after Blunt Polytrauma

Praet¹,

Kofler²,

Kruse³

et al. 2019

Arch Clin Med Case Rep

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Left ventricular (LV) pseudoaneurysms are the consequence of cardiac rupture, usually contained by adherent pericardium or fibrous scar tissue. They represent, from a functional point of view, the acquired blood-filled spaces that are external to the cardiac chambers but communicating with the ventricle. They can occur after transmural myocardial infarction or, albeit less frequently, post-traumatically. This cardiac disease has been a topic of discussion since the pioneering days of heart surgery. We present a case of a posttraumatic LV pseudoaneurysm, in which the causative blunt trauma happened 30 years prior to the onset of symptoms. Severe functional mitral regurgitation (FMR) resulted from leaflet tethering and partial rupture of the posteromedial papillary muscle complex.

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“…Следует отметить, что одним из ключевых моментов успешного хирургического лечения аневризмы ЛЖ является предоперационное планирование объема вмешательства с использованием мультимодальной визуализации [36,37]. Двухмерная ЭхоКГ является золотым стандартом, поскольку позволяет определить локализацию и размер аневризмы, дает представление о систолической и диастолической функции ЛЖ, о наличии тромба и нарушении функции МК.…”

Section: Case Reportsunclassified

Giant postinfarction posterolateral left ventricular aneurysm, complicated by mitral insufficiency

Bikbova¹,

Mazanov²,

Sagirov³

et al. 2023

Transplantologiâ (Mosk.)

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Ischemic heart disease holds the leading position in the structure of cardiovascular diseases. Early reperfusion therapy for acute myocardial infarction led to a decrease in mortality and severe complications of coronary artery disease. Despite advances in the treatment of coronary artery disease, dilatation and remodeling of the left ventricle develop in 20% of patients who have had a heart attack, leading to mitral insufficiency and systolic dysfunction of the left ventricle. Aneurysm of the left ventricle is a delayed severe complication of myocardial infarction, which significantly worsens the prognosis. Large aneurysms of the left ventricle cause progressive dilatation of the left ventricle, its volumetric overload with an increase in wall tension in the non-infarction zone, decreased functional characteristics of the left ventricle, thrombosis in the aneurysm cavity, life-threatening arrhythmias, and sudden death. Postinfarction left ventricular remodeling can lead to secondary mitral regurgitation, which is an independent predictor of mortality in the longterm period. Surgical treatment of coronary heart disease and its complications is one of the main problems of modern cardiovascular surgery.

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Multislice computed tomography-guided surgical repair of acquired posterior left ventricular aneurysms: demonstration of mitral valve and left ventricular reverse remodelling

Abstract: MSCT represents an excellent diagnostic tool for the assessment of MV and LV geometry. MSCT-guided SVR of submitral LV aneurysms leads to excellent mid-term results. On the basis of the MSCT assessment, we propose an algorithm for surgical planning in posterior LV aneurysms.

Cited by 4 publications

References 22 publications

Surgical Restoration of Antero-Apical Left Ventricular Aneurysms: Cardiac Computed Tomography for Therapy Planning

Surgical Restoration of Antero-Apical Left Ventricular Aneurysms: Cardiac Computed Tomography for Therapy Planning

Left Ventricular Pseudoaneurysmectomy and Mitral Valve Replacement 30 Years after Blunt Polytrauma

Giant postinfarction posterolateral left ventricular aneurysm, complicated by mitral insufficiency

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