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Surgical remodelling of the left ventricle. Theory and practice in the Department of Cardiac Surgery in St. Marina University Hospital, Varna, Bulgaria

Milen Slavov, Plamen Panayotov, Daniela Panayotova, Yavor Peychev, Vladimir Kornovski, Blagoi Bogdanov, Emil Yordanov

Abstract

Early and aggressive treatment of acute myocardial infarction (MI) results in a decrease of the incidence of late complications. Nowadays the evolution of about 7.6% of all cases of transmural MI of the left ventricle (LV) results in aneurysm formation. The aneurysm itself as well as other consequences of the myocardial loss is related to impaired systolic and diastolic LV function, risk of rupture of the LV wall or potentially embologenous thrombosis in the LV cavity.

These characteristics contribute to a constant trend towards timely and contemporary surgical treatment of this category of patients in terms of operative strategy and technique. It also stimulates the conduction of large and powerful trials in this field and the creation of databases including the early, midterm and late outcomes that further enhance the understanding of the most suitable treatment algorithm. Since the first surgical procedures in the 1950s, the techniques have evolved offering an individualized approach as each procedure is distinguished by its surgical complexity and achieved results.

Along with the descriptive characteristics of the evolution of surgical techniques for correction of LV aneurysms the current text also presents the experience of the Department of Cardiac Surgery in St. Marina University Hospital in Varna, Bulgaria with the surgical remodeling of the LV and the early results in this patient category. During the period 01.01.2008 – 31.12.2013 a total of 22 patients underwent myocardial revascularization and repair of LV aneurysm, 8 were with linear repair and 14 - with Dor procedure. Of the patients with linear repair 87.5% (7/8) and 85.7% (12/14) of these with Dor procedure survived the early postoperative period and presented with significantly reduced postoperative volumes and improved function of the LV. Despite the small number of cases this proves both techniques ensure acceptable surgical results for these severely ill patients.

Keywords

aneurysm of the left ventricle; surgical remodeling of the left ventricle

Full Text


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DOI: http://dx.doi.org/10.14748/hl.v22i0.5177

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