Surgical ventricular restoration based on evaluation of myocardial viability with delayed-enhanced magnetic resonance imaging.
OBJECTIVE
We examined whether the determination of myocardial viability by preoperative delayed-enhanced magnetic resonance imaging (DE-MRI) would be useful for planning surgical ventricular restoration (SVR).


METHODS
Eight consecutive patients with poor cardiac function (ejection fraction < 30%) due to ischemic cardiomyopathy underwent surgical treatment based on findings of preoperative cine-MRI and DE-MRI. Our surgical strategy consisted of (1) complete revascularization on viable segments; (2) SVR in a patient with extensive nonviable segments; and (3) mitral valve plasty in a patient with a more than moderate degree of mitral regurgitation. Based on the MRI assessments, four of the patients (group A) underwent isolated coronary bypass surgery, and the other four (group B) underwent SVR and mitral valve plasty concomitantly with coronary bypass surgery. Perioperative changes in ventricular function were quantitatively assessed in each group.


RESULTS
The mean end-diastolic volume index was reduced from 115 +/- 29 ml/m2 to 95 +/- 14ml/m2 in group A and from 163 +/- 35ml/m2 to 125 +/- 28ml/m2 in group B. The mean end-systolic volume index was reduced from 91 +/- 25ml/m2 to 68 +/- 16ml/m2 in group A and from 135 +/- 36ml/m2 to 98 +/- 28 ml/m2 in group B. The mean ejection fraction increased from 20% +/- 6% to 28% +/- 9% in group A and from 17% +/- 6% to 22% +/- 5% in group B. The mean New York Heart Association (NYHA) functional class was reduced from 3.0 +/- 0.8 to 1.8 +/- 0.6 in group A and from 3.5 +/- 0.5 to 2.2 +/- 0.2 in group B.


CONCLUSIONS
DE-MRI was highly effective in helping to select which patients and which areas of the left ventricle are indicated for SVR, which contributed to excellent early clinical outcomes.
Ogawa
Mitsugu
M
Department of Cardiovascular and Thoracic Surgery, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Japan. m-ogawa@koto.kpu-m.ac.jp
Doi
Kiyoshi
K
Yamada
Yoshiaki
Y
Fukumoto
Atsushi
A
Okawa
Kazunari
K
Kan'bara
Tamotsu
T
Koushi
Keitarou
K
Itoh
Hirotshi
H
Nishimura
Tsunehiko
T
Yaku
Hitoshi
H
D009202:Cardiomyopathies / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014022:Tissue Survival