A New Approach to Left Ventricular Aneurysms: Restoration of Ventricular Dynamics by Pericardial Patch Septoplasty
Between 1974 and 1987, 342 patients underwent left ventricular (LV) aneurysmectomy. Amongst these, 42 with septal involvement were operated upon utilizing pericardial patch septoplasty (PPS), a new surgical technique aiming to restore the anatomical and physiological features of the LV. In PPS, the normal part of the septum is “pulled up” with a pericardial patch to the LV apex, thus eliminating the paradoxical systolic movement of the infarcted septum, while at the same time the curvature of the LV free wall is preserved by a special method of closure of the ventriculotomy.
In order to evaluate the hemodynamic consequences of this technique, a prospective study was designed. Twenty-six patients who underwent LV aneurysmectomy with PPS were compared with 21 patients who were operated on using the standard aneurysmectomy technique. All patients had LV aneurysms with septal involvement and underwent left heart catheterization and left ventriculography postoperatively. The variables compared were postoperative hemodynamics parameters, morbidity and mortality, LV end-distolic pressure (LVEDP), ejection fraction (EF), and percentage of abnormally contracting segments of the LV (PACS).
Statistical analysis revealed superior postoperative hemodynamic performance in the PPS group (p < 0.05), but PPS was not found to have significant advantages in regard to LVEDP, EF, and PACS.
KeywordsLeft Anterior Descend Left Ventricular Cavity Pericardial Patch Ventricular Aneurysm Left Ventricular Apex
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