Surgical treatment of post infarction left ventricular aneurysms: our experience with double breasting and Dor's repair.
BACKGROUND
This is a retrospective study of left ventricle (LV) aneurysm repair done at the Escorts Heart Institute and Research Centre, New Delhi, since October 1988. Two methods of LV aneurysm repair are practiced: double breasting (DB) and Dor's repair. The method varies with location, size, and extent of aneurysm and quality of the fibrotic wall of the aneurysm.


METHODS
Between October 1988 and May 2001, 129 patients underwent LV aneurysm repair using one of the two techniques; 78 patients had Dor's repair while 51 patients had DB repair.


RESULTS
Overall mortality was 2.3% (three patients). One patient died in the DB group, and two patients died in the Dor's repair group. Mean preoperative ejection fraction (EF) after surgery in DB was 31% while in Dor's repair it was 29.2%. EF showed improvement after surgery to 48.5% in DB and 46.6% in Dor's repair. Decrease in end-diastolic volume (EDV) in DB was from 146 to 91.4 cm3/m2, and in Dor's repair it was from 156 cm3/m2 to 88.6 cm3/m2. Decrease in end-systolic volume was from 101 cm3/m2 to 60.2 cm3/m2 in DB and from 109 cm3/m2 to 64.5 cm3/m2 in Dor's group. All of these values showed statistically significant improvement. At six months postoperatively, 83 patients (74.1%) out of 112 patients who were preoperatively in New York Heart Association (NYHA) Functional Classes III and IV improved to class II while 7 patients (6.3%) improved to class I.


CONCLUSIONS
In our experience Dor's repair is indicated for anteroseptal and apical isolated posterior aneurysm to restore LV volume and geometry while DB is indicated for apical, anterolateral, and lateral aneurysms where septal involvement is less. These two techniques have definite indications and advantages with good results.
Trehan
Naresh
N
Escorts Heart Institute and Research Centre, New Delhi, India.
Kohli
Vijay
V
Meharwal
Zile Singh
ZS
Mishra
Yugal
Y
Sharma
Vijay Kumar
VK
Mishra
Manisha
M
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D006322:Heart Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006334:Heart Function Tests; D006352:Heart Ventricles / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis; D011183:Postoperative Complications / Q000401:mortality*; D011184:Postoperative Period; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D016277:Ventricular Function, Left