Post infarction left ventricular aneurysm—our experience

Abstract

Background

Left ventricular aneurysms (LVAs) stand as one of the serious complications of myocardial infarction and are associated with increased mortality. Considerable differences exist regarding the optimal surgical management of LVAs. In this study, we report our single center/single surgeon experience with post infarction LVAs.

Methods

This is a retrospective analysis of 25 patients, who underwent endoventricular circular patch plasty (Dor procedure) for LVAs of ischemic origin from 2009 to 2013. The demographic data was collected in addition to patients mode of presentation, New York Heart Association (NYHA) class, past medical history particularly ischemic heart disease, preoperative electrocardiography, chest X-ray, echocardiography, and coronary angiography. The postoperative functional class and the echocardiography data were also collected and analysed. All patients underwent follow-up cardiac computerized tomogram (CT) scan to calculate the sphericity index (SI).

Results

The mean age of presentation was 60.76 ± 9.57 years. Seventeen were males and eight were females. The associated comorbidities were, diabetes and hypertension. The most common presentations were, the angina and the left ventricular failure. Among the study group, two (8%) patients presented within 72 h of myocardial infarction (MI) owing to the hemodynamic instability due to ventricular septal rupture (VSR) and severe mitral regurgitation (MR), and required moderate doses of inotropes and intra-aortic balloon pump. The time of presentation in the remaining 23 (92%) patients ranged from 14 to 38 days following the MI (mean −21.36 ± 0.38 days). The preoperative mean NYHA functional class was 2.44 ± 0.71. Posterior aneurysms were predominated in our study. The mean left ventricular internal diameter in diastole (LVIDd), the left ventricular internal diameter in systole (LVIDs) and the ejection fraction (EF) were; 6.52 ± 0.40 cm, 5.24 ± 0.37 cm, and 37.44 ± 3.92% respectively. The mean end-diastolic volume (EDV) was 167 ± 28.38 ml and the mean end-systolic volume (ESV) was 87.84 ± 12.90 ml. The mean pulmonary artery systolic pressure (PASP) was 51.48 ± 5.72 mmHg. The mean tricuspid annular plane systolic excursion (TAPSE) was 11.52 ± 0.71 mm. Six cases showed mural thrombus, four had MR, and one had an associated ventricular septal defect (VSD). The coronary angiogram showed multivessel coronary artery disease in majority of patients. The hospital mortality was 8% (two cases). The mean follow-up period was 2.4 ± 0.91 years. The postoperative mean NYHA class was 1.76 ± 0.43. There was a significant improvement in the left ventricular function. There was a significant improvement in MR following concomitant Dor procedure and mitral valve interventions. Patients with mitral interventions had trivial to mild MR and were asymptomatic. The mean SI was 0.5 ± 0.11.

Conclusion

Dor procedure is reproducible and simple to perform, restores the natural left ventricular geometry and is associated with significant improvement in the left ventricular performance and hemodynamics, which translates into improved functional class of the patient.

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