PubMed · 255409
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V K Zhestovskiĭ, E V Vinogradov. 1979. [Heart aneurysm].. https://pubmed.ncbi.nlm.nih.gov/255409/
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OBJECTIVE: Scant attention has been directed towards quantifying the degree of mechanical disadvantage produced by akinetic and dyskinetic aneurysms. The purpose of this study was to evaluate the mechanical disadvantages of simulated akinetic and dyskinetic aneurysms on left ventricular function. METHODS: An elaborate experimental apparatus consisting of a computer-controlled water pressure chamber in which is suspended a model rubber ventricle was developed. The system has been shown to reproduce accurately the ventricular and aortic pressures found in vivo. In this study, a procedure was designed to simulate akinetic and dyskinetic aneurysms of various sizes on ventricular function. RESULTS: The results indicated that an akinetic aneurysm produces little or no mechanical disadvantage with respect to ventricular pressure since systolic paradox is minimal. However, a dyskinetic aneurysm, irrespective of size, will usually compromise ventricular function due to paradoxical systolic expansion in the bulging aneurysmic sac. In vivo, other factors, such as blood coagulation and rhythm disturbances, may influence these results. CONCLUSIONS: An akinetic aneurysm causes little or no mechanical disadvantage while the dyskinetic aneurysm, irrespective of size. will restrict ventricular function. The experimental simulation system, notwithstanding its limitations, thus provides a unique procedure to quantify akinetic and dyskinetic aneurysms.
For the past four decades, the standard approach to the treatment of left ventricular aneurysms has been to resect the aneurysm wall and close it in a linear fashion. During the past decade, evidence has accumulated that this simple approach may not be the most efficacious in terms of either short-term ventricular function or long-term survival and quality of life. To establish the basis against which the newer techniques are to be compared, this article describe the historical evolution of procedures designed to treat ventricular aneurysms, the pathophysiolgy of aneurysms, the standard surgical technique still used by most surgeons, and the rationale for the newer surgical approaches.
The endoventricular circular patch plasty (EVCPP) technique was first used by us in 1984 to re-establish a more normal morphology of the left ventricular cavity distorted by post-myocardial infarction scar tissue. This technique includes the placement of a subendocardial circumferential pursestring suture inside the left ventricle around the base of the aneurysm at the junction of scarred and normal endocardium. A patch is then placed at this level to establish a new contour for the left ventricular cavity. Because this patch is placed at the junction of scar and normal endocardium, a substantial portion of the distal ventricular septum is excluded from the left ventricular cavity. The overall hospital mortality in our series of more than 715 cases is approximately 7% and, in the survivors, the ejection fraction is increased an average of 0.10.