Pericardial repair of endocardial defect following regional endocardial resection for ventricular tachycardia.
Regional endocardial resection is the accepted surgical treatment for sustained monomorphic ventricular tachycardia. In patients requiring extensive endocardial resection, or with large aneurysms involving the interventricular septum, the resulting defect may result in weakened myocardium and, ultimately, ventricular septal defect or ventricular rupture. A new approach for repair of the resulting defect is proposed using an autogenous pericardial patch sutured to normal endocardium and included in the aneurysm repair. This technique was performed in six patients undergoing surgery for drug refractory ventricular tachycardia. All patients had large anterior left ventricular aneurysms with endocardial scar extending onto the septum. The large endocardial defect left after endocardial resection and aneurysmectomy was repaired with a pericardial patch. No intraoperative complications (e.g., suture line bleeding) were observed as a result of this technique. All patients are alive, and five of the six patients no longer have inducible ventricular tachycardia. An improvement in congestive heart failure symptoms at 1-9 months of follow-up was noted following surgery. We conclude that the pericardium can be safely used to cover endocardial defects resulting from regional endocardial resection for sustained ventricular tachycardia.
Szentpetery
S
S
Division of Cardiology and Cardiothoracic Surgery, Medical College of Virginia, Richmond.
Cohen
M D
MD
Welch
W J
WJ
Bauernfeind
R A
RA
Ellenbogen
K A
KA
D000818:Animals; D002304:Cardiac Pacing, Artificial; D003452:Cryosurgery; D004699:Endocardium / Q000601:surgery*; D006322:Heart Aneurysm / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation*; D013536:Suture Techniques; D013610:Tachycardia / Q000601:surgery*; D014182:Transplantation, Autologous