Surgical treatment of cardiac lipoma: 20 years' experience in a single center.

BACKGROUND:Primary cardiac lipoma is very rare, and no consensus has been developed regarding its ideal treatment strategy. This study reviewed the surgical treatment of cardiac lipomas in 20 patients over 20 years.METHODS:Twenty patients with cardiac lipomas were treated at Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College from January 1, 2002, to January 1, 2022. The patients' clinical data and pathological reports were retrospectively analyzed, and the follow-up with a range of 1 year to 20 years was conducted.RESULTS:The cardiac lipomas were located in the right atrium (RA) or superior vena cava (SVC) in seven patients (35%) (RA in six patients and SVC in one patient), left ventricle in eight patients (40%) (left ventricular chamber in four patients and left ventricular subepicardium and myocardium in four patients), right ventricle in three patients (15%) (right ventricular chamber in one patient and right ventricular subepicardial layer and myocardium in two patients), subepicardial interventricular groove in one patient (5%), and pericardium in one patient (5%). Complete resection was achieved in 14 patients (70%), including seven patients with lipomas in the RA or SVC. Incomplete resection occurred in six patients (30%) with lipomas in the ventricles. No perioperative deaths occurred. Long-term follow-up was conducted for 19 patients (95%), including two (10%) who died. Both patients who died had lipomas incompletely resected due to ventricles involvement, and preoperative malignant arrhythmias persisted post-operatively.CONCLUSIONS:The complete resection rate was high, and the long-term prognosis was satisfactory in patients with cardiac lipomas that did not involve the ventricle. The complete resection rate was low in patients with cardiac lipomas in ventricles; and complications, including malignant arrhythmia, were common. Failure of complete resection and post-operative ventricular arrhythmia are correlated with post-operative mortality.

Fractal Geometry Illustrated Left Atrial Appendage Morphology That Predicted Thrombosis and Stroke in Patients With Atrial Fibrillation.

Background:This study aims to correlate the morphological complexity of left atrial appendage (LAA) with thrombosis and stroke in patients with atrial fibrillation (AF).Methods:The training cohort consisted of 46 patients with AF (age 55.8 ± 7.2 years, 73.9% men) who were referred for radiofrequency catheter ablation. An independent validation cohort consisting of 443 patients with AF was enrolled for further verification. All patients in the training cohort underwent both transesophageal echocardiography (TEE) and enhanced computed tomography (CT). Fractal dimension (FD) analysis was performed to evaluate the morphological complexity of LAAs quantitatively. Clinical and imaging manifestations, FD of LAAs, and diagnostic accuracy were investigated and compared between patients with AF in both training and validation cohorts.Results:In the training cohort, LAAs (n = 22) with thrombi had significantly higher FD than those without thrombi (n = 24) h 0.44 ± 0.07 vs. 2.35 ± 0.11, p = 0.003). Receiver-operating characteristic (ROC) analysis suggested that the diagnostic accuracy of FD combined with a CHA2DS2-VaSc score was significantly higher than that of the CHA2DS2-VaSc score alone in low- to moderate-risk patients with AF (area under the curve 0.8479 vs. 0.6958, p = 0.009). The results were also validated in an independent external validation cohort and demonstrated that increased FD was associated with stroke. Hemodynamic analysis revealed that LAAs with thrombi and high FD were prone to blood stasis and lower blood flow rate.Conclusion:LAA morphological complexity is closely associated with thrombosis and stroke in patients with paroxysmal AF. A new risk assessment system combining CHA2DS2-VaSc score and FD has a higher diagnostic accuracy in predicting LAA thrombosis.

Surgical radiofrequency ablation of atrial flutter: which operation should we choose?

The treatment of atrial flutter (AFL) in patients without structural heart disease (SHD) by transcatheter radiofrequency ablation of the cavotricuspid isthmus (CTI) and bilateral pulmonary veins has achieved good results. We report three cases of typical AFL treated by surgical radiofrequency ablation. One patient, without SHD, successfully underwent CTI ablation and cardioversion. The other two patients, with SHD, underwent CTI ablation, partial right atrial ablation and pulmonary vein isolation, but a normal sinus rhythm was not achieved. Therefore, standard maze IV surgery may be the best choice in patients with AFL and SHD.

Degenerative Mitral Valve Repair: From Etiology, Pathology, Surgical Strategy to Durability.

Do patients with complete transposition of the great arteries and severe pulmonary hypertension benefit from an arterial switch operation?

BACKGROUND:Whether an arterial switch operation benefits patients with transposition of the great arteries and severe pulmonary hypertension (PH) remains controversial. Therefore, we evaluated the relationship between preoperative PH and early and midterm clinical outcomes after an arterial switch procedure.METHODS:In this retrospective study, 101 consecutive patients with transposition of the great arteries underwent an arterial switch operation between February 2004 and October 2007. Seventy had a ventricular septal defect as well; patients with intact ventricular septum and complicated concomitant abnormities were excluded. Preoperative medical records were reviewed and mean follow-up was 22.4±15.2 months. After sternotomy, we directly measured pulmonary artery pressure before and after instituting extracorporeal circulation. Patients were divided into three groups according to mean pulmonary artery pressure (mPAP): control group (mPAP<25 mm Hg, n=23), moderate PH group (mPAP 25 to 50 mm Hg, n=37), and severe PH group (mPAP≥50 mm Hg, n=10). Early and midterm results were compared among groups.RESULTS:Postoperatively, pulmonary artery pressure of both the moderate and severe PH groups decreased significantly. There were no significant differences in occurrence of postoperative complications or in-hospital mortality in the three groups (control group, 8.7%; moderate PH group, 8.1%; severe PH group, 10%; p=0.98). However, midterm mortality differed significantly (control group, 4.3%; moderate PH group, 2.7%; severe PH group, 40%; p<0.01).CONCLUSIONS:Patients with transposition of the great arteries and mPAP less than 50 mm Hg can achieve satisfying results after an arterial switch operation. However, even though the operation can decrease pulmonary artery pressure, patients with preoperative mPAP greater than 50 mm Hg still suffer from high midterm mortality.

Apical conicity ratio: a new index on left ventricular apical geometry after myocardial infarction.

OBJECTIVE:Our objective was to introduce a new index to evaluate left ventricular aneurysm by quantitative analysis of left ventricular apical geometry.METHODS:A total of 116 selected subjects underwent magnetic resonance imaging, 28 healthy volunteers, 29 patients with dilated cardiomyopathy, and 59 patients with ischemic heart disease (26 with left ventricular aneurysm; 33 with no aneurysm). The apical conicity ratio was calculated as the ratio of left ventricular apical area over apical triangle.RESULTS:Diastolic apical conicity ratio of patients with left ventricular aneurysm was 1.62 ± 0.20 and systolic apical conicity ratio was 1.78 ± 0.43. After left ventricular reconstruction, the diastolic apical conicity ratio decreased to 1.47 ± 0.23 and the systolic ratio to 1.51 ± 0.21, which came close to the normal level, whereas other global indices remained. In patients with dilated cardiomyopathy, sphericity index and eccentricity index increased significantly without changes in the apical conicity ratio. Among patients with ischemic heart disease, the apical conicity ratio of the group with left ventricular aneurysm was significantly higher than that of the group without an aneurysm when the other indices between the 2 groups showed no statistically difference. Receiver operating characteristic curves showed only apical conicity ratio had high power of discriminating left ventricular aneurysm from no aneurysm.CONCLUSIONS:The new index, apical conicity ratio, can be used to quantify the regional left ventricular deformation, especially in patients with left ventricular aneurysm resulting from myocardial infarction.

Left ventricular reconstruction with no-patch technique: early and late clinical outcomes.

BACKGROUND:Few studies have evaluated late clinical outcome of no-patch technique in patients with large left ventricular aneurysms. The objectives of this study were to evaluate a no-patch surgical technique to reconstruct the left ventricle in patients with left ventricular aneurysm and to assess early and late clinical outcomes.METHODS:In 1995, we began using a no-patch technique in patients with dyskinetic left ventricular aneurysms. A total of 145 patients underwent left ventricular reconstruction with this technique and were followed up for (59 ± 29) months (range, 1 - 127 months). Risk factors for early mortality were analyzed by bivariate analyses. Cox's proportional hazards model was used to calculate risk factors for all-cause mortality and hospital readmission. Kaplan-Meier methodology was used to analyze late survival.RESULTS:One week after operation, left ventricular end-diastolic diameter had decreased from (61 ± 8) mm to (55 ± 8) mm, and geometry of the left ventricle was restored to a more normal conical shape. Early mortality was 3% and late mortality 11%. Over a 5-year follow-up period, hospital readmission was 28%. One-, 5-, and 10-year survival estimates were 95% (95% confidence interval (CI) 91% - 99%), 86% (95%CI 78% - 94%), and 74% (95%CI 60% - 88%). Readmission-free survival at 1 and 5 years after operation was 87% (95%CI 81% - 93%) and 60% (95%CI 50% - 70%), respectively.CONCLUSION:The no-patch technique for left ventricular reconstruction is an effective and simple procedure that can achieve satisfactory early and late clinical outcomes in patients with left ventricular aneurysms.

Risk factors and prevention of upper gastrointestinal hemorrhage after a coronary artery bypass grafting operation.

PURPOSE:Upper gastrointestinal (GI) hemorrhage is a serious complication of coronary artery bypass grafting (CABG). The aim of this study was to retrospectively investigate the risk factors and prevention of upper GI bleeding after CABG.METHODS:This study followed 6316 coronary patients who underwent CABG from 1998 to 2005. The perioperative parameters were recorded. Data from patients who experienced major gastrointestinal complications were analyzed retrospectively by univariate and multivariate analyses.RESULTS:The rate of upper GI bleeding was 0.3%. The overall mortality for patients complicated by upper GI bleeding was 47.6%. The risk factors for upper GI bleeding were age (odds ratio [OR] = 3.18, 95% confidence interval [CI] = 1.73-5.87, P < 0.01), extracorporeal circulation time (OR = 1.30, 95% CI = 1.11-1.52, P < 0.01) and the prophylactic use of omeprazole (OR = 0.19, 95% CI = 0.04-0.89, P < 0.05). The long-term mortality was significantly different between the upper GI bleeding group and the controls (P < 0.01).CONCLUSION:Advanced age and extracorporeal circulation time were risk factors for upper GI bleeding after CABG, and the prophylactic use of omeprazole decreased the rate of upper GI bleeding.

[Effects of left ventricular reconstruction on magnetic resonance imaging derived left ventricular wall stress and contractive function in patients with postinfarction ventricular aneurysm].

OBJECTIVE:To evaluate the effects of left ventricular reconstruction on left ventricular wall stress and function in patients with postinfarction left ventricular aneurysm.METHODS:During January 2005 to June 2006, 16 patients [15 male, (56.6 +/- 8.8) years] with postinfarction ventricular aneurysm received left ventricular reconstruction operation on CPB (5 linear repair, 6 endoventricular purse-string suture, 5 endoventricular patch repair) and CABG was also performed in 15 patients. MRI examination was made before and 3 months post operation by Siemens Magnetom Avanto 1.5T MR with routine cine-MRI in combination with late-delayed enhancement sequence. Left ventricular geometric parameters and segmental thickening were obtained with accessory image analysis software. Non-invasive blood pressure was acquired in order to compute ventricular wall stress. The revascularized and unrevascularized segments were defined by comparing the post operation revascularization of the blood-supply coronary artery with preoperative results.RESULTS:A total of 192 segments including 74 unrevascularized segments were analyzed. Segmental thickening were significantly increased while wall stress were significantly reduced in both unrevascularized and revascularized segments 3 months post operation compared to preoperative values (all P < 0.05). The increase of wall thickening was positively correlated with the reduction of wall stress in these segments.CONCLUSION:Left ventricular reconstruction plus CABG is associated with reduced left ventricular wall stress and increased myocardial contractive function in patients with postinfarction left ventricular aneurysm.

Repair of left ventricular aneurysm: ten-year experience in Chinese patients.

BACKGROUND:A large transmural myocardial infarction often results in a dyskinetic or akinetic left ventricular aneurysm (LVA). This study aimed to explore the early and long-term clinical outcomes and to identify predictors for survivals and hospital re-admission after the repair of left ventricular aneurysm.METHODS:We followed up 497 patients who had undergone LVA repair from a single center in China between 1995 and 2005. The perioperative parameters were recorded. Risk factors for early mortality and long-term results were analyzed by multivariate Logistic regression. Cox's proportional hazard model was used to calculate risk factors for major adverse cardiac and cerebrovascular events, cause of death and re-admission. Kaplan-Meier curve was employed to analyze long-term survival.RESULTS:The operative mortality was 2.0%. The long-term mortality was 11.1% and cardiac causes contributed to 61.8% of the overall long-term mortality. Four hundred and thirty-two patients survived during the follow-up period and 37.5% of them had been re-admitted at least one time. One hundred and five patients experienced major adverse cardiac and cerebrovascular events. Survival analysis exhibited that the probability of survival at 1 and 5 years after operation was 96% and 86% respectively. Previous atrial fibrillation was the independent risk factor for early mortality. Independent risk factors for long-term mortality were poor left ventricular ejection fraction and stroke,and risk factors for cardiac mortality were intraventricular block, stroke and poor left ventricular ejection fraction. Stroke, intraventricular block and advanced age were independent risk factors for major adverse cardiac and cerebrovascular events, and New York Heart Association (NYHA) class III-IV was the only risk factor for hospital re-admission.CONCLUSIONS:Postinfarction LVA can be repaired and satisfying early and long-term clinical outcome can be obtained. Endoventricular circular plasty technique is the better choice than linear repair in patients with large LVA. Survival is affected in patients with poor heart function, intraventricular block and stroke.

Surgical treatment of cardiac lipoma: 20 years' experience in a single center.

BACKGROUND:Primary cardiac lipoma is very rare, and no consensus has been developed regarding its ideal treatment strategy. This study reviewed the surgical treatment of cardiac lipomas in 20 patients over 20 years.METHODS:Twenty patients with cardiac lipomas were treated at Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College from January 1, 2002, to January 1, 2022. The patients' clinical data and pathological reports were retrospectively analyzed, and the follow-up with a range of 1 year to 20 years was conducted.RESULTS:The cardiac lipomas were located in the right atrium (RA) or superior vena cava (SVC) in seven patients (35%) (RA in six patients and SVC in one patient), left ventricle in eight patients (40%) (left ventricular chamber in four patients and left ventricular subepicardium and myocardium in four patients), right ventricle in three patients (15%) (right ventricular chamber in one patient and right ventricular subepicardial layer and myocardium in two patients), subepicardial interventricular groove in one patient (5%), and pericardium in one patient (5%). Complete resection was achieved in 14 patients (70%), including seven patients with lipomas in the RA or SVC. Incomplete resection occurred in six patients (30%) with lipomas in the ventricles. No perioperative deaths occurred. Long-term follow-up was conducted for 19 patients (95%), including two (10%) who died. Both patients who died had lipomas incompletely resected due to ventricles involvement, and preoperative malignant arrhythmias persisted post-operatively.CONCLUSIONS:The complete resection rate was high, and the long-term prognosis was satisfactory in patients with cardiac lipomas that did not involve the ventricle. The complete resection rate was low in patients with cardiac lipomas in ventricles; and complications, including malignant arrhythmia, were common. Failure of complete resection and post-operative ventricular arrhythmia are correlated with post-operative mortality.

Fractal Geometry Illustrated Left Atrial Appendage Morphology That Predicted Thrombosis and Stroke in Patients With Atrial Fibrillation.

Background:This study aims to correlate the morphological complexity of left atrial appendage (LAA) with thrombosis and stroke in patients with atrial fibrillation (AF).Methods:The training cohort consisted of 46 patients with AF (age 55.8 ± 7.2 years, 73.9% men) who were referred for radiofrequency catheter ablation. An independent validation cohort consisting of 443 patients with AF was enrolled for further verification. All patients in the training cohort underwent both transesophageal echocardiography (TEE) and enhanced computed tomography (CT). Fractal dimension (FD) analysis was performed to evaluate the morphological complexity of LAAs quantitatively. Clinical and imaging manifestations, FD of LAAs, and diagnostic accuracy were investigated and compared between patients with AF in both training and validation cohorts.Results:In the training cohort, LAAs (n = 22) with thrombi had significantly higher FD than those without thrombi (n = 24) h 0.44 ± 0.07 vs. 2.35 ± 0.11, p = 0.003). Receiver-operating characteristic (ROC) analysis suggested that the diagnostic accuracy of FD combined with a CHA2DS2-VaSc score was significantly higher than that of the CHA2DS2-VaSc score alone in low- to moderate-risk patients with AF (area under the curve 0.8479 vs. 0.6958, p = 0.009). The results were also validated in an independent external validation cohort and demonstrated that increased FD was associated with stroke. Hemodynamic analysis revealed that LAAs with thrombi and high FD were prone to blood stasis and lower blood flow rate.Conclusion:LAA morphological complexity is closely associated with thrombosis and stroke in patients with paroxysmal AF. A new risk assessment system combining CHA2DS2-VaSc score and FD has a higher diagnostic accuracy in predicting LAA thrombosis.

Surgical radiofrequency ablation of atrial flutter: which operation should we choose?

The treatment of atrial flutter (AFL) in patients without structural heart disease (SHD) by transcatheter radiofrequency ablation of the cavotricuspid isthmus (CTI) and bilateral pulmonary veins has achieved good results. We report three cases of typical AFL treated by surgical radiofrequency ablation. One patient, without SHD, successfully underwent CTI ablation and cardioversion. The other two patients, with SHD, underwent CTI ablation, partial right atrial ablation and pulmonary vein isolation, but a normal sinus rhythm was not achieved. Therefore, standard maze IV surgery may be the best choice in patients with AFL and SHD.

Degenerative Mitral Valve Repair: From Etiology, Pathology, Surgical Strategy to Durability.

Do patients with complete transposition of the great arteries and severe pulmonary hypertension benefit from an arterial switch operation?

BACKGROUND:Whether an arterial switch operation benefits patients with transposition of the great arteries and severe pulmonary hypertension (PH) remains controversial. Therefore, we evaluated the relationship between preoperative PH and early and midterm clinical outcomes after an arterial switch procedure.METHODS:In this retrospective study, 101 consecutive patients with transposition of the great arteries underwent an arterial switch operation between February 2004 and October 2007. Seventy had a ventricular septal defect as well; patients with intact ventricular septum and complicated concomitant abnormities were excluded. Preoperative medical records were reviewed and mean follow-up was 22.4±15.2 months. After sternotomy, we directly measured pulmonary artery pressure before and after instituting extracorporeal circulation. Patients were divided into three groups according to mean pulmonary artery pressure (mPAP): control group (mPAP<25 mm Hg, n=23), moderate PH group (mPAP 25 to 50 mm Hg, n=37), and severe PH group (mPAP≥50 mm Hg, n=10). Early and midterm results were compared among groups.RESULTS:Postoperatively, pulmonary artery pressure of both the moderate and severe PH groups decreased significantly. There were no significant differences in occurrence of postoperative complications or in-hospital mortality in the three groups (control group, 8.7%; moderate PH group, 8.1%; severe PH group, 10%; p=0.98). However, midterm mortality differed significantly (control group, 4.3%; moderate PH group, 2.7%; severe PH group, 40%; p<0.01).CONCLUSIONS:Patients with transposition of the great arteries and mPAP less than 50 mm Hg can achieve satisfying results after an arterial switch operation. However, even though the operation can decrease pulmonary artery pressure, patients with preoperative mPAP greater than 50 mm Hg still suffer from high midterm mortality.

Apical conicity ratio: a new index on left ventricular apical geometry after myocardial infarction.

OBJECTIVE:Our objective was to introduce a new index to evaluate left ventricular aneurysm by quantitative analysis of left ventricular apical geometry.METHODS:A total of 116 selected subjects underwent magnetic resonance imaging, 28 healthy volunteers, 29 patients with dilated cardiomyopathy, and 59 patients with ischemic heart disease (26 with left ventricular aneurysm; 33 with no aneurysm). The apical conicity ratio was calculated as the ratio of left ventricular apical area over apical triangle.RESULTS:Diastolic apical conicity ratio of patients with left ventricular aneurysm was 1.62 ± 0.20 and systolic apical conicity ratio was 1.78 ± 0.43. After left ventricular reconstruction, the diastolic apical conicity ratio decreased to 1.47 ± 0.23 and the systolic ratio to 1.51 ± 0.21, which came close to the normal level, whereas other global indices remained. In patients with dilated cardiomyopathy, sphericity index and eccentricity index increased significantly without changes in the apical conicity ratio. Among patients with ischemic heart disease, the apical conicity ratio of the group with left ventricular aneurysm was significantly higher than that of the group without an aneurysm when the other indices between the 2 groups showed no statistically difference. Receiver operating characteristic curves showed only apical conicity ratio had high power of discriminating left ventricular aneurysm from no aneurysm.CONCLUSIONS:The new index, apical conicity ratio, can be used to quantify the regional left ventricular deformation, especially in patients with left ventricular aneurysm resulting from myocardial infarction.

Left ventricular reconstruction with no-patch technique: early and late clinical outcomes.

BACKGROUND:Few studies have evaluated late clinical outcome of no-patch technique in patients with large left ventricular aneurysms. The objectives of this study were to evaluate a no-patch surgical technique to reconstruct the left ventricle in patients with left ventricular aneurysm and to assess early and late clinical outcomes.METHODS:In 1995, we began using a no-patch technique in patients with dyskinetic left ventricular aneurysms. A total of 145 patients underwent left ventricular reconstruction with this technique and were followed up for (59 ± 29) months (range, 1 - 127 months). Risk factors for early mortality were analyzed by bivariate analyses. Cox's proportional hazards model was used to calculate risk factors for all-cause mortality and hospital readmission. Kaplan-Meier methodology was used to analyze late survival.RESULTS:One week after operation, left ventricular end-diastolic diameter had decreased from (61 ± 8) mm to (55 ± 8) mm, and geometry of the left ventricle was restored to a more normal conical shape. Early mortality was 3% and late mortality 11%. Over a 5-year follow-up period, hospital readmission was 28%. One-, 5-, and 10-year survival estimates were 95% (95% confidence interval (CI) 91% - 99%), 86% (95%CI 78% - 94%), and 74% (95%CI 60% - 88%). Readmission-free survival at 1 and 5 years after operation was 87% (95%CI 81% - 93%) and 60% (95%CI 50% - 70%), respectively.CONCLUSION:The no-patch technique for left ventricular reconstruction is an effective and simple procedure that can achieve satisfactory early and late clinical outcomes in patients with left ventricular aneurysms.

Risk factors and prevention of upper gastrointestinal hemorrhage after a coronary artery bypass grafting operation.

PURPOSE:Upper gastrointestinal (GI) hemorrhage is a serious complication of coronary artery bypass grafting (CABG). The aim of this study was to retrospectively investigate the risk factors and prevention of upper GI bleeding after CABG.METHODS:This study followed 6316 coronary patients who underwent CABG from 1998 to 2005. The perioperative parameters were recorded. Data from patients who experienced major gastrointestinal complications were analyzed retrospectively by univariate and multivariate analyses.RESULTS:The rate of upper GI bleeding was 0.3%. The overall mortality for patients complicated by upper GI bleeding was 47.6%. The risk factors for upper GI bleeding were age (odds ratio [OR] = 3.18, 95% confidence interval [CI] = 1.73-5.87, P < 0.01), extracorporeal circulation time (OR = 1.30, 95% CI = 1.11-1.52, P < 0.01) and the prophylactic use of omeprazole (OR = 0.19, 95% CI = 0.04-0.89, P < 0.05). The long-term mortality was significantly different between the upper GI bleeding group and the controls (P < 0.01).CONCLUSION:Advanced age and extracorporeal circulation time were risk factors for upper GI bleeding after CABG, and the prophylactic use of omeprazole decreased the rate of upper GI bleeding.

[Effects of left ventricular reconstruction on magnetic resonance imaging derived left ventricular wall stress and contractive function in patients with postinfarction ventricular aneurysm].

OBJECTIVE:To evaluate the effects of left ventricular reconstruction on left ventricular wall stress and function in patients with postinfarction left ventricular aneurysm.METHODS:During January 2005 to June 2006, 16 patients [15 male, (56.6 +/- 8.8) years] with postinfarction ventricular aneurysm received left ventricular reconstruction operation on CPB (5 linear repair, 6 endoventricular purse-string suture, 5 endoventricular patch repair) and CABG was also performed in 15 patients. MRI examination was made before and 3 months post operation by Siemens Magnetom Avanto 1.5T MR with routine cine-MRI in combination with late-delayed enhancement sequence. Left ventricular geometric parameters and segmental thickening were obtained with accessory image analysis software. Non-invasive blood pressure was acquired in order to compute ventricular wall stress. The revascularized and unrevascularized segments were defined by comparing the post operation revascularization of the blood-supply coronary artery with preoperative results.RESULTS:A total of 192 segments including 74 unrevascularized segments were analyzed. Segmental thickening were significantly increased while wall stress were significantly reduced in both unrevascularized and revascularized segments 3 months post operation compared to preoperative values (all P < 0.05). The increase of wall thickening was positively correlated with the reduction of wall stress in these segments.CONCLUSION:Left ventricular reconstruction plus CABG is associated with reduced left ventricular wall stress and increased myocardial contractive function in patients with postinfarction left ventricular aneurysm.

Repair of left ventricular aneurysm: ten-year experience in Chinese patients.

BACKGROUND:A large transmural myocardial infarction often results in a dyskinetic or akinetic left ventricular aneurysm (LVA). This study aimed to explore the early and long-term clinical outcomes and to identify predictors for survivals and hospital re-admission after the repair of left ventricular aneurysm.METHODS:We followed up 497 patients who had undergone LVA repair from a single center in China between 1995 and 2005. The perioperative parameters were recorded. Risk factors for early mortality and long-term results were analyzed by multivariate Logistic regression. Cox's proportional hazard model was used to calculate risk factors for major adverse cardiac and cerebrovascular events, cause of death and re-admission. Kaplan-Meier curve was employed to analyze long-term survival.RESULTS:The operative mortality was 2.0%. The long-term mortality was 11.1% and cardiac causes contributed to 61.8% of the overall long-term mortality. Four hundred and thirty-two patients survived during the follow-up period and 37.5% of them had been re-admitted at least one time. One hundred and five patients experienced major adverse cardiac and cerebrovascular events. Survival analysis exhibited that the probability of survival at 1 and 5 years after operation was 96% and 86% respectively. Previous atrial fibrillation was the independent risk factor for early mortality. Independent risk factors for long-term mortality were poor left ventricular ejection fraction and stroke,and risk factors for cardiac mortality were intraventricular block, stroke and poor left ventricular ejection fraction. Stroke, intraventricular block and advanced age were independent risk factors for major adverse cardiac and cerebrovascular events, and New York Heart Association (NYHA) class III-IV was the only risk factor for hospital re-admission.CONCLUSIONS:Postinfarction LVA can be repaired and satisfying early and long-term clinical outcome can be obtained. Endoventricular circular plasty technique is the better choice than linear repair in patients with large LVA. Survival is affected in patients with poor heart function, intraventricular block and stroke.