Ventricle - left Flashcards

1
Q

Classification of ventricular aneurysms

A

True aneurysm and false (pseudoaneurysm)

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2
Q

‘True’ ventricular aneurysm

A

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.

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3
Q

‘False’ ventricular aneurysm

A

pseudoaneurysm. Due to contained rupture of ventricle wall

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4
Q

Indication for surgery of a ventricular aneurysm

A

Large ‘true’ aneurysm that contributes to angina or heart failure. Almost all pseudoaneurysm (unless small and incidentally noted)

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5
Q

Left ventricular free wall ‘rupture’ operative mortality.

A

Almost always lethal without surgery. Operative mortality 25%.

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6
Q

Operative techniques for LV free wall rupture

A

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

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7
Q

Initial management of Post-infarct VSD

A

IABP, or ECLS if severe end organ damage

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8
Q

Mortality rate of Post-infarct VSD

A

at least 25% in 1 day of diagnosis; 80% in 1 month

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9
Q

Operative techniques for Post-infarct VSD

A

Patch exclusion is better than patch repair; or total artificial heart

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10
Q

Indication for surgical intervention for LV aneurysm (7)

A

Symptoms of heart failure, angina, arrhythmia, mural thrombus, enlargement, pseudoaneurysm, and embolism

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11
Q

Name of trial on management of LV aneurysm

A

STITCH trial

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12
Q

STITCH TRIAL

1) Inclusion criteria
2) Cohorts of the study
3) Findings

A
  • 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.
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