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J Thorac Cardiovasc Surg 2004;128:21-26
© 2004 The American Association for Thoracic Surgery

Editorial

Early and late results of left ventricular reconstruction in thin-walled chambers: Is this our patient population?

^a Department of Surgery, Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif, USA
^b Option of Bioengineering, California Institute of Technology, Pasadena, Calif, USA

Received for publication November 26, 2003; accepted for publication March 16, 2004.

^* Address for reprints: Gerald D. Buckberg, MD, David Geffen School of Medicine at UCLA, Division of Cardiothoracic Surgery, PO Box 951741, 62-258 Center for the Health Sciences, Los Angeles, CA 90095-1741, USA
gbuckberg@mednet.ucla.edu

The first 300 words of the full text of this article appear below.

See related article on page 27.

 

Left ventricular aneurysms with a thin wall were commonplace before treatment of acute infarction with reperfusion by either thrombolysis or percutaneous angioplasty. The classic surgical approach to this region was made by collapse of the scarred region, and the procedure on the free wall was described in 1959 by Cooley and colleagues¹ and in 1985 was enlarged to the septum by Jatene² and Dor and associates.³ The report in this issue⁴ follows the Mickleborough group's earlier presentation in 2000⁵ and refocuses attention on the role of chamber rebuilding in patients with thin-walled ventricles after either anterior or inferior infarctions. There is general avoidance of mitral procedures and exclusion of patients with pulmonary hypertension. The long-term results and hospital mortality were excellent in this subset of patients with congestive heart failure (CHF), especially because 83% of patients were in New York Heart association functional III or IV class. Conventional medical management has been associated with high mortality in this class.

The evaluation for candidacy has become more critical, with magnetic resonance imaging (MRI) recently used to measure end-systolic volume index, directly correlates with prognosis.⁶ Such vital data help to identify restrictions inherent in visualizing only motion by ejection fraction, as well as defining previous echocardiographic limitations. For example, they look at the distal third of the ventricle, rather than left ventricular end-diastolic diameter. This is useful, because ischemic disease causes nonhomogeneous dilation from anterior infarction beyond the bases of the papillary muscles used for left ventricular end-diastolic diameter calculations. Evaluations of size that use traditional left ventricular end-diastolic diameter values may be misleading in ischemic disease and are more useful for homogeneous global dilatation that follows aortic or mitral valve disorders or nonischemic disease.

Furthermore, use of endocardiectomy in 41% of patients decreased late . . . [Full Text of this Article]

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