Ventricle - left Flashcards
Classification of ventricular aneurysms
True aneurysm and false (pseudoaneurysm)
‘True’ ventricular aneurysm
Due to dilation and remodeling of a transmural infarction. Well-defined, isolated scars composed of fibrous tissue that are devoid of muscle, thinned out, bulding outward, akinetic or dyskinetic.
‘False’ ventricular aneurysm
pseudoaneurysm. Due to contained rupture of ventricle wall
Indication for surgery of a ventricular aneurysm
Large ‘true’ aneurysm that contributes to angina or heart failure. Almost all pseudoaneurysm (unless small and incidentally noted)
Left ventricular free wall ‘rupture’ operative mortality.
Almost always lethal without surgery. Operative mortality 25%.
Operative techniques for LV free wall rupture
a. Excision of infarct and patch repair. Not ideal for new infarcts and poor tissue integrity.
b. Direct closure with felt pledgets
c. Patch and glue repair. A small rent in the myocardial tissue is covered with bovine pericardium ~2 cm larger than the size of the defect + Bioglue
Initial management of Post-infarct VSD
IABP, or ECLS if severe end organ damage
Mortality rate of Post-infarct VSD
at least 25% in 1 day of diagnosis; 80% in 1 month
Operative techniques for Post-infarct VSD
Patch exclusion is better than patch repair; or total artificial heart
Indication for surgical intervention for LV aneurysm (7)
Symptoms of heart failure, angina, arrhythmia, mural thrombus, enlargement, pseudoaneurysm, and embolism
Name of trial on management of LV aneurysm
STITCH trial
STITCH TRIAL
1) Inclusion criteria
2) Cohorts of the study
3) Findings
- Inclusion: EF <35% and operable CAD
- Cohorts:
1. Medical therapy alone vs. CABG + medical
2. CABG + medical vs. CABG + medical + surgical ventricular reconstruction (SVR) - Survival benefit was realized in CABG + SVR compared to CABG alone when a postoperative end-systolic volume index of 70 mL/m2 or less was achieved.
- Little added benefit in most patients.
