title: Restoration of optimal left ventricular apical geometry and rotation following surgical ventricular restoration using rectangular patch plasty technique: a pilot study using cardiac magnetic resonance.
abstract: OBJECTIVE
  Clinical outcomes of surgical ventricular restoration (SVR) have been confirmed by Registry data. Accurate assessment of left ventricular (LV) morphology and function can help optimize these outcomes.
  
  
  METHODS
  LV remodelling in 7 patients (NYHA class 3 ± 1.2) with post-myocardial infarction LV aneurysms was characterized by the regional LV volume (RLVV) computed by dividing the LV in cine steady-state free precession cardiac magnetic resonance imaging (CMR) at each slice level into six radial segments. Rotation of the LV apex and base was analysed using tagged CMR. The apical conicity ratio was used to characterize the restored apical geometry.
  
  
  RESULTS
  The mean end-diastolic volume (EDV) was 174.8 ± 100.3 ml and the mean ejection fraction (EF) was 18.8 ± 7.8%. Following SVR, all patients had significant clinical improvements (NYHA Class I), and significant increases in the left ventricular ejection fraction (LVEF) to 38.8 ± 4.4%. The LV volumes and regional volumes at the base and apex decreased with a trend towards significance. The mean preoperative apical conicity ratio (ACR) was 1.90 ± 0.43 and, following SVR by endoventricular linear patch plasty (EVLPP), was 1.35 ± 0.3 (P = 0.02). The percent decrease in the ACR following SVR from baseline was 28.68 ± 10.98%. The apical EF increased from 1.19 ± 13.9 to 15.8 ± 8.2% (P = 0.028). The basal rotations improved from 3.13 ± 2.1 to 4.69 ± 2.94° (P = 0.04). The apical rotations also improved significantly from 2.48 ± 1.23 to 3.93 ± 2.45° (P = 0.05) and reversed to the normal anticlockwise direction.
  
  
  CONCLUSIONS
  SVR by geometric repair using a rectangular intracavitary patch helps restoration of a physiological apex with normalization of apical rotation reflecting a near-physiological LV function.
authors.affiliation: Department of Cardiology, St John's Medical College Hospital, Bangalore, India srili2881967@yahoo.com.
authors.forename: Srilakshmi M
authors.initials: SM
authors.lastname: Adhyapak
authors.affiliation: Department of Electrical and Computer Engineering, SYSU-CMU Joint Institute of Engineering, Pittsburgh, USA Shunde International Research Institute, Guangdong, China QuantMD LLC, Pittsburgh, USA.
authors.forename: Prahlad G
authors.initials: PG
authors.lastname: Menon
authors.affiliation: Department of Cardiac Surgery, Narayana Hrudayalya Institute of Medical Sciences, Bangalore, India.
authors.forename: V Rao
authors.initials: VR
authors.lastname: Parachuri
authors.affiliation: Department of Cardiac Surgery, Narayana Hrudayalya Institute of Medical Sciences, Bangalore, India.
authors.forename: Karthik
authors.initials: K
authors.lastname: Gadabanahalli
authors.affiliation: Department of Cardiac Surgery, Narayana Hrudayalya Institute of Medical Sciences, Bangalore, India.
authors.forename: Venkat Ramana
authors.initials: VR
authors.lastname: Bhat
authors.affiliation: Department of Cardiac Surgery, Narayana Hrudayalya Institute of Medical Sciences, Bangalore, India.
authors.forename: Varun
authors.initials: V
authors.lastname: Shetty
authors.affiliation: Department of Cardiac Surgery, Narayana Hrudayalya Institute of Medical Sciences, Bangalore, India.
authors.forename: Devi
authors.initials: D
authors.lastname: Shetty
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D005260:Female; D006322:Heart Aneurysm / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012399:Rotation; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: Aneurysm; Cardiac volume; Imaging; Ventricles