Regional myocardial performance of non-ischaemic zones remote from anterior wall left ventricular aneurysm. Effects of aneurysmectomy.
The aim of this work was to investigate the effects of resecting a post-infarction left ventricular anterior aneurysm on the kinetics of the non-ischaemic inferior wall, remote from the healed lesion. Thirteen patients, with an anterior post-infarction aneurysm and a normal right coronary artery who underwent aneurysmectomy with endoventricular circular patch plasty reconstruction, had a complete haemodynamic study before and shortly after surgery. The shape of the left ventricle was quantitatively analysed by calculating the regional curvature at 90 points of the angiographic outlines (30 degrees right anterior oblique projection). Segmental wall motion was studied by means of the centreline method and by constructing pressure-length loops from the endocardial movement of 18 chords intersecting the left ventricular inferior contour and by simultaneously tracing the high-fidelity left ventricular pressure. Analysis of pressure-length regional loops showed a complex pattern of abnormal contraction and relaxation in the non-ischaemic inferior regions at baseline; after surgery such abnormalities decreased significantly and tended to revert to normal in many cases. Left ventricular shape in the inferior region was abnormal in 10/13 patients in that there was negative curvature at the interface between the aneurysm and the inferior wall that was corrected to positive after surgery. Regional inferior wall motion and global ejection fraction significantly improved after surgery in these 10 patients. The three patients whose global ejection fraction did not improve showed no inferior negative curvature pre-operatively, nor did they show an increase in inferior wall motion. The results indicate that regional function and shape in inferior, non-ischaemic regions, remote from an anterior aneurysm, are abnormal but potentially correctible if the abnormal mechanical burden imposed on the wall is relieved.
Di Donato
M
M
Department of Internal Medicine, University of Florence, Italy.
Sabatier
M
M
Toso
A
A
Barletta
G
G
Baroni
M
M
Dor
V
V
Fantini
F
F
D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006322:Heart Aneurysm / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000209:etiology*; D016277:Ventricular Function, Left / Q000502:physiology; D017725:Ventricular Pressure / Q000502:physiology