Objective To summarize clinical characteristics and treatment results of adult patients with coronary heart disease and ventricular aneurysm，and evaluate surgical outcomes. Methods Clinical data of 86 adult patients with coronary heart disease and ventricular aneurysm who underwent surgical treatment in Fu Wai Hospital from January 2011 to November 2012 were retrospectively analyzed. There were 70 male and 16 female patients with their average age of 57.7±10.6 years and average body weight of 71.7±10.5 kg. Preoperative echocardiography or left ventriculography showed left ventricular thrombus in 22 patients. Coronary angiography showed 47 patients with 3 vessel disease，29 patientswith 2 vessel disease，and 10 patients with single vessel disease. Sixteen patients underwent direct linear suturing of theaneurysm off pump，39 patients underwent simple linear suturing under cardiopulmonary bypass，15 patients received endoventricular purse-string reconstruction，and 16 patients received endoventricular purse-string reconstruction and patch plasty. Three patients underwent reexploration for bleeding. Sixty-four patients received concomitant coronary artery bypass grafting（CABG）. Results Postoperatively 2 patients（2.3%） died of refractory ventricular fibrillation and multiple organ dysfunction syndrome respectively. Patients undergoing concomitant CABG received 2.3±1.2 grafts on the average. Seventy-eightpatients （92.9%） were followed up for 2-24 months after discharge. During follow-up，patients’ angina symptoms significantlyresolved，heart function improved in varying degrees，and no new sign of myocardial ischemia was found on electrocardiogram.Left ventricular ejection fraction （LVEF） was significantly higher than preoperative LVEF（51%±7% vs. 41%±9% ，t=6.20，P=0.00），and left ventricular end-diastolic diameter （LVEDD） was significantly smaller than preoperative LVEDD （54.2±6.2 mm vs. 56.0±6.8 mm，t=4.60，P=0.00） . Conclusion Ventricular aneurysm repair and concomitant CABG （or ventricular septal perforation repair，mitral valvuloplasty et al） are positive and effective treatment strategies for postinfarction ventricular aneurysm. Satisfactory clinical outcomes can be achieved by individualized treatment based on appropriate surgical strategies according to the size of ventricular aneurysm.
Abstract： Objective To evaluate clinical outcomes of plication of left ventricular aneurysm during off-pump coronary artery bypass grafting （OPCAB）. Methods A total of 114 patients who underwent coronary artery bypass grafting （CABG） and concomitant surgical treatment for left ventricular aneurysm from January 2007 to January 2011 in Beijing Anzhen Hospital were included in this study. All the patients were divided into 2 groups according to the different surgical procedures they received. In groupⅠ， there were 76 patients including 57 males and 19 females with their average age of （63.4±7.8） years who underwent CABG and left ventricular aneurysmectomy under cardiopulmonary bypass on the non-beating heart. In groupⅡ， there were 38 patients including 32 males and 6 females with their average age of （60.6±8.9） years who underwent OPCAB and plication of the left ventricular aneurysm on the beating heart. Preoperative data were not statistically different between the 2 groups except that the percentage of the left ventricular aneurysm to the left ventricle of groupⅠwas significantly larger than that of groupⅡ（42.2%±13.6% vs. 26.5%±12.3％， t=5.499， P=0.000）. Postoperative clinical outcomes and morbidities were compared between the 2 groups， and all the patients were followed up for 6 months. Results There was 2 in-hospital death in groupⅠ， one for postoperative refractory ventricular arrhythmia， and the other for severe pneumonia. There was 1 in-hospital death in groupⅡ because of perioperative myocardial infarction. Postoperative thoracic drainage， incidence of reexploration for bleeding， mechanical ventilation time and incidence of intra-aortic balloon pump （IABP） implantation were not statistically different between the 2 groups （P＞0.05）. To compare their echocardiography outcomes at early postoperative stage and 6 months after discharge with preoperative values， left ventricular end-diastolic dimensions （LVEDD） at early postoperative stage and 6 months after discharge were both signific antly decreased than preoperative value in both groups ［groupⅠ： （54.0±7.8） mm amp; （56.0±8.1） mm vs. （59.6±6.6） mm， groupⅡ： （52.0±7.2） mm amp; （53.6±5.3） mm vs. （57.9±5.4） mm］， and left ventricular ejection fraction （LVEF） at early postoperative stage and 6 months after discharge were both significantly higher than preoperative value in both groups （groupⅠ：43.5%±3.2％ amp; 55.7%±3.7% vs. 38.0%±7.4%， groupⅡ：44.7%±2.8％ amp; 57.0%±3.5% vs. 41.0%±6.6%）， but there was no statistical difference in LVEDD and LVEF between the 2 groups（P＞0.05）. Conclusion Plication of left ventricular aneurysm during OPCAB is a safe and effective surgical procedure， and possibly more appropriate for patients with a smaller left ventricular aneurysm.
ObjectiveTo analyze clinical outcomes of coronary artery bypass grafting (CABG) without concomitant surgical ventricular restoration (SVR) for patients with coronary artery disease (CHD) and left ventricular aneurysm (LVA). MethodsA total of 105 patients with CHD and LVA underwent surgical treatment in Wuhan Asia Heart Hospital from January 2008 to December 2012. Among them,74 patients were found to have no clear boundary LVA,poor wall motion or no obvious contradictory wall motion during surgical exploration,and didn't received SVR,including 59 male and 15 female patients with their age of 60.96±9.09 years. Coronary angiography showed 5 patients with single-vessel disease,10 patients with double-vessel disease,45 patients with triple-vessel disease,and 14 patients with left main and triple vessel disease. Intraoperative findings showed no clear boundary LVA in 30 patients,apical thinning without obvious LVA in 29 patients,LVA without obvious contradictory wall motion but thickening of the apex in 15 patients. All the 74 patients received CABG including 62 patients undergoing on-pump CABG and 12 patients undergoing off-pump CABG. Seventy patients received left internal mammary artery to left anterior descending anastomosis,and 2 patients received endarterectomy of the left anterior descending coronary artery. For moderate to severe mitral regurgitation,3 patients received concomitant mitral valvuloplasty,and 2 patients received concomitant mitral valve replacement. One patient received concomitant aortic valve replacement for severe aortic stenosis. ResultsPostoperatively,2 patients (2.7%) died of malignant arrhythmia and hypoxic ischemic encephalopathy respectively. Six patients received intra-aortic balloon pump (IABP) support for low cardiac output syndrome,perioperative myocardial infarction and malignant arrhythmias. Seventy patients were followed up after discharge for 24-60 (43±12) months. During follow-up,left ventricular thrombus was found in 8 patients,disappeared within 1 year after warfarin treatment in 5 patients,and no thromboembolic event happened. Echocardiogram showed that LVA disappeared in 18 patients (25.7%). Ejection fraction (EF) at discharge,6 months and 1 years after discharge were significantly higher than preoperative EF (EF at 6 months after discharge versus preoperative EF:44%±6% vs. 39%±5%). Left ventricular end-diastolic diameter (LVEDD,LVEDD at 6 months after discharge versus preoperative LVEDD:54.37±6.28 mm vs. 59.24±6.24 mm) and left ventricular end-systolic diameter (LVESD) were significantly reduced compared with preoperative values (P<0.01). But as time went by,LVEDD and LVESD gradually became larger than those values at discharge. ConclusionFor patients with CHD and LVA,CABG without SVR,which is decided according to actual surgical exploration,can significantly improve postoperative EF,LVEDD and LVESD,but left ventricular enlargement may happen progressively after discharge.
Abstract: Objective To evaluate the treatment efficacy of post-infarction left ventricular pseudo-aneurysm (LVPA) through surgical procedure, and explore the diagnosis and differential diagnosis details of LVPA. Methods Between May 1993 and July 2007, 7 cases were diagnosed through echocardiography aided with left ventriculography or multi-sliced computer tomography (MSCT) or magnetic resonance imaging (MRI); 6 cases with LVPA were surgically treated through different procedure that included direct closure, cut and patching or cut and sandwiching procedure choose according to its location, anatomical morphology, and comorbidity; accompanied diseases were treated by coronary artery bypass grafting(CABG) procedure. Results Six cases were diagnosed before surgery, and 1 case was diagnosed during the surgical procedure. One died from the cardiac tamponade due to rupture of LVPA before the surgical procedure, so the inhospital mortality was 14.3%（1/7）. There was no operative death. With the follow-up from 2 months to 13 years of the 6 operational survivors, 1 case died from cardiac rupture and pericardial tamponade 4 years after the repair procedure. Of the 5 surviving LVPA, the left ventricular ejection fraction(LVEF) values were from 43% to 52%, and 3 cases were in New York Heart Association (NYHA) class Ⅰ, and 2 cases were in NYHA class Ⅱ. Conclusion Echocardiography, aided with left ventriculography or MSCT or MRI, is an effective measure for diagnosis of LVPA. Surgical procedure is an effective measure to treat LVPA,but different surgical procedures, accompanied with homeochronous CABG procedure,should be adopted to deal with LVPA according its location, anatomical morphology, and accompanied deformity. The perioperative and mid-long term efficacy were good for the surgical treatment of LVPA, but it is imperative to pay attention to prevention of the recurrence and the late rupture of repaired LVPA.
Objective To discuss left ventricular reconstruction methods and effectivness in patients with left ventricular aneurysm after myocardial infarction. Methods Between June 2003 and August 2008, 23 patients with left ventricular aneurysm after myocardial infarction were treated. Of them, 13 were male and 10 were female with an average age of 61.2 years (range, 47-74 years). According to New York Heart Association (NYHA) criteria for cardiac function, there were 3 cases of grade I, 6 cases of grade II, 10 cases of grade III, and 4 cases of grade IV. The coronary arteriongraphy showed singlevesseldisease in 2 cases, double-vessel disease in 5 cases, triple-vessel disease in 16 cases. The locations of ventricular aneurysm were the apex cordis in 18 cases, antetheca and parieslateral is in 4 cases, and interior wall in 1 case. The left ventricular ejection fraction was 36.52%± 12.15%, and left ventricular diastol ic final diameter was (62.30 ± 6.52 ) mm. Nine patients received standard l inear repair, 6 patients received standard l inear repair after endocardial ring shrinkage, and 8 patients received patch suture after endocardial ring shinkage. Results Two cases died perioperatively, and re-thoracotomy was performed to stop bleeding in 1 case. Incisions healed by first intention in the other patients without early compl ication. Twentyone patients were followed up 7-48 months (median, 19 months). At 6 months after surgery, the left ventricular ejection fraction 46.52% ± 9.41% were significanly improved when compared with that at preoperation (t=2.240, P=0.023); the left ventricular diastol ic final diameter (52.23 ± 5.11) mm were significantly decreased when compared with that at preoperation (t=2.170, P=0.035). The cardiac function according to NYHA criteria was at grade I in 8 cases and at grade II in 13 cases. One patient died of cerebral hemorrhage at 18 months after operation and the activities of daily l iving recoverd in the others. Conclusion Individual theraputic methods are used according to patients’ different conditions for left ventricular aneurysm after myocardial infarction.
Abstract: Objective To evaluate the early and long-term results for the management of giant left ventricular aneurysm with comparison of different surgical ventricular restructive approaches. Methods Between January 1992 and December 2004, 148 consecutive patients underwent repair of giant left ventricular aneurysms and were divided into two groups, conventional group： 89 patients were submitted to linear repair; modified group： 59 patients were submitted to endocardium encircle suturing remodeling（EESR）. There were no significant difference in New York Heart Association （NYHA） class Ⅲ /Ⅳ , left ventricular dysfunction before operation, aortic clamp time and number of coronary bypass grafts in two groups. Results Five patients died after operation （3. 4%）, 4 cases in conventional group and 1 case in modified group, the hospital mortality rate was 4.5% vs. 1.7% （P=0. 320）. The major morbidity were low cardiac output syndrome and ventricular fibrillation. One hundred and thirty-four patients （93.7 % ） were followed up, during a mean follow-up of 51.4± 27.0 months （range 1-120 months）, 21 patients had died. The NYHA class more than m in the early stage after operation was the independent risk factor for late death （P= 0. 000）. Actuarial survival rates were 91.6% of modified group vs. 76.3% of conventional group at 5 years （P=0.040）, and 91.6% vs. 61.4% at 8 years（P=0.000）. At late follow-up the meanNYHAclass, left ventricular end-diastolic dimension （LVEDD） and left ventricular ejection fraction （LVEF） were significant improved （P = 0. 000）in both groups. The rate of re-dilatation of LVEDD was higher in conventional group than that in modified group （ 38.8% vs. 16.7%, P= 0. 030）. Conclusion The technique of repair of postinfarction dyskinetic giant left ventricular aneurysms should be adapted in each patient to the cavity size and shape, and the dimension of the scar. The EESR achieves better results with respect to perioperative mortality, late functional status and survival than linear repair.
ObjectiveTo investigate the efficacy of bipolar radiofrequency ablation for left ventricular aneurysm-related ventricular arrhythmia associated with mural thrombus. MethodsFifteen patients with left ventricular aneurysm-related frequent premature ventricular contractions associated with mural thrombus were enrolled in Beijing Anzhen Hospital between June 2013 and June 2015. There were 11 male and 4 female patients with their age of 63.5±4.8 years. All patients had a history of myocardial infarction, but no cerebral infarction. All patients received bipolar radiofrequency ablation combined with coronary artery bypass grafting, ventricular aneurysm plasty and thrombectomy. Holter monitoring and echocardiography were measured before discharge and 3 months following the operation. ResultsThere was no death during the operation. Cardiopulmonary bypass time was 92.7±38.3 min. The aortic clamping time was 52.4±17.8 min.The number of bypass grafts was 3.9±0.4. All the patients were discharged 7-10 days postoperatively. None of the patients had low cardiac output syndrome, malignant arrhythmias, perioperative myocardial infarction, or cerebral infarction in this study. Echocardiography conducted before discharge showed that left ventricular end diastolic diameter was decreased (54.87±5.21 cm vs. 60.73±6.24 cm, P=0.013). While there was no significant improvement in ejection fraction (45.20%±3.78% vs. 44.47%±6.12%, P=1.00) compared with those before the surgery. The number of premature ventricular contractions[4 021.00 (2 462.00, 5 496.00)beats vs. 11 097.00 (9 327.00, 13 478.00)beats, P < 0.001] and the percentage of premature ventricular contractions[2.94% (2.12%, 4.87%) vs. 8.11% (7.51%, 10.30%), P < 0.001] in 24 hours revealed by Holter monitoring were all significantly decreased than those before the surgery. At the end of 3-month follow-up, all the patients were angina and dizziness free. Echocardiography documented that there was no statistical difference in left ventricular end diastolic diameter (55.00±4.41 mm vs. 54.87±5.21 mm, P=1.00). But there were significant improvements in ejection fraction (49.93%±4.42% vs. 45.20%±3.78%, P=0.04) in contrast to those before discharge. Holter monitoring revealed that the frequency of premature ventricular contractions[2 043.00 (983.00, 3 297.00)beats vs. 4 021.00 (2 462.00, 5 496.00)beats, P=0.03] were further lessened than those before discharge, and the percentage of premature ventricular contractions[2.62% (1.44%, 3.49%)vs. 8.11% (7.51%, 10.30%), P < 0.001] was significantly decreased than those before the surgery, but no significant difference in contrast to those before discharge. ConclusionThe recoveries of cardiac function benefit from integrated improvements in myocardial ischemia, ventricular geometry, pump function, and myocardial electrophysiology. Bipolar radiofrequency ablation can correct the electrophysiological abnormality, significantly decrease the frequency of premature ventricular contractions, and further improve the heart function.
Objective To compare the clinic results between offpump left ventricular(LV) aneurysm plication repair and onpump LV linear aneurysmectomy for LV dyskinetic aneurysm (DA), and to improve the curative effect of aneurysm. [WTHZ]Methods From September 2003 to September 2007, 32 patients with DA located in the anterior wall or apex of LV were operated. There were 23 male and 9 female aged 4670 years with a mean age of 63 years. According to the procedure with or without cardiopulmonary bypass(CPB), 32 patients were divided into two groups: Offpump group (n=17), with the size of DA represented 25%-37% of left cavity. Patients in this group underwent offpump LV aneurysm plication repair; Onpump group (n=15), with the size of DA represented 27%-40% of left cavity. Patients in this group underwent onpump LV linear aneurysmectomy. Coronary artery bypass grafting was the concomitant procedure in both groups. The clinic results were compared and evaluated via indexes such as left ventricular volume, systolic function etc which were determined by echocardiography. [WTHZ]Results No operation death was found in both groups. In offpump group, there was no perioperative complication. Postoperative cardiac function classification (NYHA) improved significantly (1.0±0.8 grade vs. 2.9±0.3 grade，P=0.001), left ventricular ejection fraction（LVEF） improved significantly (41.0%±4.5% vs. 36.4%±4.8%，P=0.035), and left ventricular [CM(159mm]endsystolic volume index (LVESVI) reduced significantly (52.6±27.7 ml/m2 vs. 79.7±21.4 ml/m2, P=0.003) compared with that before operation. Seventeen cases were followed up, and the followup time was 12-53 months with a mean time of 29 months. No death was found during following up. One case was reoperated 1 year after operation because of severe mitral valve regurgitation. One case had congestive heart failure 3 years after operation with a LVEF of 31% and still in observation. The other cases were fine. In onpump group, there were 3 cases had perioperative complications (Two with neurological complications and one with respiratory failure). Postoperative cardiac function classification (NYHA) improved significantly (1.0±0.6 grade vs. 3.1±0.9 grade，P=0.001). LVEF improved significantly (42.3%±3.2% vs. 35.6%±6.5%, P=0.023). LVESVI reduced obviously (49.3±22.6 ml/m2 vs. 81.3±25.0 ml/m2, P=0.003) compared with that before operation. Fifteen cases were followed up and the followup time was 1260 months with a mean time of 35 months. No death was found during following up and the clinic results were good. No significant difference was observed between the two groups (Pgt;0.05). [WTHZ]Conclusion Offpump LV aneurysm plication repair for LV dyskinetic aneurysm can effectively reduce the volume of LV, improve LVEF and cause less perioperative complications. It is a safe and effective procedure. Its longterm prognosis needs further observation.
Objective To summarize the experiences of surgical treatment for post infarction ventricular aneurysm and mi tral regurgitation， thus to improve surgical curative effect and survival rates . Clinical data of 37 patients with myocardial infarction complicated with ven tricular aneurysm and severer than moderate mitral regurgitation were retrospectively an alyzed between December 2000 and June 2007, all 37 patients underwent coron ary artery bypass grafting and reconstruction of left ventricular after aneurysm resection, mitral valve repair or replacement. Results Three patients died during hospital stay after surgery,mortality rate was 81%, of th em two died in renal failure, one died in brain complications.Thirty patients we re followed up, followup rate was 88.2%(30/34), with 4 patients missed. Follow up time ranged from 1 month to 6 years after surgery, 2 patients died in foll o wup period, of them one died in anticoagulant treatment failure complicated w ith the large cerebral infarction, one died of lung infection and heart failure. The inner diameter of le ft atrium and enddiastolic left ventricle reduced obviously than those before operation （30.1±3.5mm vs.39.3±3.7mm, P=0.004;48.4±4.3mm vs.61.2±5.1mm, P=0.003）by color doppler echocardiography examination at 6th month a fter su rgery.There was no obvious change in size of untouched ventricular aneurysm(diam eterlt;5cm). No regurgitation or slight regurgitation were observed in 12 patient s, mild regurgitation was observed in 2 patients and moderate in 1 patients. Conclusion According to different types of post infarctio n ventricular aneurysm and mitral regurgitation, constitution o f different surgical treatment programs, can result in favorable early and long-term curative effect. There’s marked improvement in most patients’cardiac f unction and survival rate.
ObjectiveTo evaluate the effects of modified left ventricular reconstruction (LVR) and linear repair (LR) to post-infarct left ventricular aneurysm (LVA) and summarize the surgical experience of LVA. MethodsFrom May 2004 to December 2011, 47 patients were admitted in the Department of Cardiovascular Surgery, Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University. There were 25 patients underwent LVR (group LVR, including 21 males and 4 females), 18 patients underwent LR (group LR, including 14 males and 4 females) and 4 patients underwent directly sutured (including 3 males and 1 female). Among them, 42 patients underwent coronary artery bypass grafting (CABG). During 6-24 months'follow-up, left ventricular ejection fraction (LVEF), quality of life and activity were measured. ResultsPostoperative LVEF was significantly higher than preoperative LVEF in group LVR(49.2%±13.6% vs. 32.5%±12.9%, P < 0.05) and group LR (47.5%±11.6% vs. 36.9%±11.6%, P < 0.05). One patient died in LR group (5.5%) and 1 died in LVR group (4.0%), no death occurred in directly sutured surgery. Total mortality was 4.2%. ConclusionLVR and LR are both effective treatment for LVA. Personalized treatment can receive satisfactory short-and long-term outcomes.