title: Septal reshaping for exclusion of anteroseptal dyskinetic or akinetic areas.
abstract: BACKGROUND
  Our purpose is to describe a technique for exclusion of anteroseptal dyskinetic or akinetic areas.
  
  
  METHODS
  From January to December 2002, 22 consecutive patients with myocardial infarction following left anterior descending artery occlusion underwent septal reshaping. All of them were admitted for dyspnea. Eight patients were referred for angina. After a 5 to 8 cm apical incision, 2 U stitches were passed from inside to join the anterior wall to the septum, as high as possible, following the border of the scars. An oval Dacron patch was then sutured from the septum (end of the direct suture through the border with the inferior septum) to the anterior wall (between the healthy and the scarred wall) up to the new apex. Purpose of the procedure is to maintain a longitudinal size as similar as possible to the normal. The incision was closed in a double layer.
  
  
  RESULTS
  No patient died and only one had acute renal failure. No patients had restrictive syndrome. After a mean follow-up of 6.7 +/- 3.6 months (3 to 15), mean New York Heart Association Class improved from 2.7 +/- 1.1 to 1.2 +/- 0.3 (p < 0.001). Echocardiographic results showed reduction of left ventricle volumes and normalization of the stroke volume. In patients with low ejection fraction (<or=35%), left ventricular volumes decreased with a concomitant ejection fraction increase and a normal stroke volume. In patients with smaller cavities, significant reduction of left ventricular cavities was also obtained, with similar changes in ejection fraction and normal stroke volume.
  
  
  CONCLUSIONS
  This technique treats all the dyskinetic or akinetic areas following left anterior descending artery occlusion, when the septal involvement is higher than the anterior free wall. Clinical and morphologic results are good.
authors.affiliation: Division of Cardiac Surgery, University Hospital, Torino, Italy. calafiore@unich.it
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Calafiore
authors.forename: Michele Di
authors.initials: MD
authors.lastname: Mauro
authors.forename: Gabriele
authors.initials: G
authors.lastname: Di Giammarco
authors.forename: Sabina
authors.initials: S
authors.lastname: Gallina
authors.forename: Angela L
authors.initials: AL
authors.lastname: Iacò
authors.forename: Marco
authors.initials: M
authors.lastname: Contini
authors.forename: Antonio
authors.initials: A
authors.lastname: Bivona
authors.forename: Stefano
authors.initials: S
authors.lastname: Volpe
mesh_terms: D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial; D002921:Cicatrix / Q000209:etiology / Q000601:surgery; D004452:Echocardiography; D005260:Female; D006346:Heart Septum / Q000473:pathology / Q000601:surgery*; D006351:Heart Valves / Q000601:surgery; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology; D013318:Stroke Volume; D013903:Thoracic Surgery / Q000379:methods*; D016277:Ventricular Function, Left