title: Multislice computed tomography-guided surgical repair of acquired posterior left ventricular aneurysms: demonstration of mitral valve and left ventricular reverse remodelling.
abstract: Involvement of the mitral valve (MV) apparatus represents a challenge in surgical ventricular repair (SVR) of posterior left ventricular (LV) aneurysms. This study sought to investigate whether multislice computed tomography (MSCT) assessment can be used to optimize the surgical procedure for posterior LV aneurysms.
  
  
  
  Thirty patients (m : w = 24 : 6, age 38-78, median 66 years; mean New York Heart Association class 2.98) with posterior LV aneurysm were operated upon. MSCT was performed in 24 patients before and after surgery. End-diastolic and end-systolic volumes of LV and aneurysm were indexed to body surface area (LVEDVI/LVESVI, AEDVI/AESVI). The MV apparatus was characterized by coaptation distance (CD), tenting area (TA), MV closure angle (MVCA), MV annulus area (MVAA) and interpapillary muscle distance (IMD).
  
  
  
  Thirty-day mortality was 10% and 5-year survival rate was 83%. After surgery, LVEDVI decreased from 151.2 ± 84.1 to 85.7 ± 28.3 ml/m(2) (P = 0.001) and LVESVI from 110.6 ± 88.8 to 50.2 ± 22.9 ml/m(2) (P = 0.001). LV ejection fraction increased from 31.5 ± 15.1 to 43.4 ± 9.9% (P = 0.001). Preoperative MSCT showed significantly higher values of MVAA, CD and TA in patients who needed MV repair or replacement. Postoperative reduction of mitral regurgitation in patients without MV surgery corresponded with significant reduction in intercommissural diameter, anteroposterior diameter, MVAA, TA, CD, MVCA and IMD.
  
  
  
  MSCT represents an excellent diagnostic tool for the assessment of MV and LV geometry. MSCT-guided SVR of submitral LV aneurysms leads to excellent mid-term results. On the basis of the MSCT assessment, we propose an algorithm for surgical planning in posterior LV aneurysms.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Natalia
authors.initials: N
authors.lastname: Solowjowa
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Adam
authors.initials: A
authors.lastname: Penkalla
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Dandel
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Alexei
authors.initials: A
authors.lastname: Novikov
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.
authors.forename: Miralem
authors.initials: M
authors.lastname: Pasic
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Yuguo
authors.initials: Y
authors.lastname: Weng
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany knosalla@dhzb.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Knosalla
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D005260:Female; D006322:Heart Aneurysm / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D061330:Multidetector Computed Tomography; D015996:Survival Rate; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: Aneurysm; Heart failure; Imaging; Mitral valve; Myocardial infarction