OBJECTIVE: The effectiveness of the left ventricle (LV) geometry reconstruction (Dor procedure) as the method of surgical treatment of LV post-infarction aneurysm and large dilated myocardial scars is well established. The efficacy of LV restoration in cases of globally dilated hypofunctional LV, containing the same spherical architecture as scarred, remains questionable. METHODS: The results of LV geometry reconstruction in small population of patients with ischemic dilated cardiomyopathy (IDCMP) and predominantly hypokinetic LV are described in 14 patients of that underwent LV rebuilding into a conical architecture. Surgical procedures included LV geometry reconstruction with the synthetic patch, narrowing of widened dimensions between papillary muscles, coronary artery bypass grafting (CABG) and, in several cases, mitral and tricuspid valves annuloplasty. RESULTS: Initial mean end-diastolic and end-systolic volumes indexes were 177 and 112 ml/m2, respectively, mean LV ejection fraction (EF) of 32.9%. The analysis of immediate and mid-term (1 and 4 years) results proved that LV reconstruction markedly decreased LV volumes and increased LVEF an average of +12% above resting values with significant improvement in clinical status. CONCLUSIONS: A rebuilding procedure for the scarred heart is now introduced to be used in ischemic patients with dilated ischemic cardiomyopathy without significant scar. Preliminary structural and physiological results imply that creating an elliptical form has potential importance during LV reconstruction of very sick patients with IDCMP without discrete scar.
OBJECTIVE: The effectiveness of the left ventricle (LV) geometry reconstruction (Dor procedure) as the method of surgical treatment of LV post-infarction aneurysm and large dilated myocardial scars is well established. The efficacy of LV restoration in cases of globally dilated hypofunctional LV, containing the same spherical architecture as scarred, remains questionable. METHODS: The results of LV geometry reconstruction in small population of patients with ischemic dilated cardiomyopathy (IDCMP) and predominantly hypokinetic LV are described in 14 patients of that underwent LV rebuilding into a conical architecture. Surgical procedures included LV geometry reconstruction with the synthetic patch, narrowing of widened dimensions between papillary muscles, coronary artery bypass grafting (CABG) and, in several cases, mitral and tricuspid valves annuloplasty. RESULTS: Initial mean end-diastolic and end-systolic volumes indexes were 177 and 112 ml/m2, respectively, mean LV ejection fraction (EF) of 32.9%. The analysis of immediate and mid-term (1 and 4 years) results proved that LV reconstruction markedly decreased LV volumes and increased LVEF an average of +12% above resting values with significant improvement in clinical status. CONCLUSIONS: A rebuilding procedure for the scarred heart is now introduced to be used in ischemicpatients with dilated ischemic cardiomyopathy without significant scar. Preliminary structural and physiological results imply that creating an elliptical form has potential importance during LV reconstruction of very sick patients with IDCMP without discrete scar.
Authors: Paulo Sérgio Juliani; Eder França da Costa; Aristides Tadeu Correia; Rosangela Monteiro; Fabio Biscegli Jatene Journal: Rev Bras Cir Cardiovasc Date: 2014 Jul-Sep