Surgical treatment of congestive heart failure: evolving options

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Date of download: 5/31/2016 Copyright © 2016 McGraw-Hill Education. All rights reserved. Evaluation of the patient with known or suspected ischemic heart.

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Surgical treatment of congestive heart failure: evolving options Bartley P. Griffith, MD The Annals of Thoracic Surgery Volume 76, Issue 6, Pages S2254-S2259 (December 2003) DOI: 10.1016/j.athoracsur.2003.09.008

Fig 1 Example of positron emission tomography (PET) mismatch pattern in a patient with chronic ischemic left ventricular dysfunction demonstrating an irreversible perfusion defect on 99mTc-sestamibi single photon-emission computed tomography (SPECT). Stress myocardial perfusion SPECT images (left panel) show severely reduced defects in the apical, anteroapical, and septal regions that persist on the rest images (fixed defects). These findings are commonly interpreted to represent large myocardial infarction in the left anterior descending (LAD) vascular territory. Rest 13N-ammonia images (top, middle panel) show markedly decreased perfusion in the apical and anteroapical regions. However 18F-fluorodeoxyglucose (FDG) images (bottom, middle panel) acquired under glucose-loaded condition show preserved glucose utilization in the abnormally perfused myocardial regions at rest (perfusion-metabolism mismatch pattern), a scinitigraphic marker of hibernation. A coronary angiogram (right panel) shows 95% stenosis of the proximal LAD coronary artery (arrow) associated with akinesis of the apical and anteroseptal regions and a calculated left ventricular ejection fraction of 20%. The Annals of Thoracic Surgery 2003 76, S2254-S2259DOI: (10.1016/j.athoracsur.2003.09.008)

Fig 2 (A) Apicoanterolateral aneurysm with limited septal involvement. (B) The double-breasting technique includes advancement of the lateral myocardial wall onto the septum at the junction of scar and normal tissue. (C) Dor's technique: a Dacron patch lined with pericardium is sutured circumferentially at the junction of scar and normal muscle with a large septal involvement. (From Trehan N, et al. J Card Surg 2003;18:114–20. Reprinted with permission from Blackwell Publishing.) The Annals of Thoracic Surgery 2003 76, S2254-S2259DOI: (10.1016/j.athoracsur.2003.09.008)

Fig 3 Buckberg modification of the Dor technique. A preformed circular patch is sized by ends of a cardiac encircling suture. The Annals of Thoracic Surgery 2003 76, S2254-S2259DOI: (10.1016/j.athoracsur.2003.09.008)

Fig 4 The ACORN cardiac restraint device. The Annals of Thoracic Surgery 2003 76, S2254-S2259DOI: (10.1016/j.athoracsur.2003.09.008)

Fig 5 (A) Central insufficiency of mitral valve as tested intraoperatively in a patient with severe left ventricular dysfunction and enlargement. There is loss of coaptation of the leaflets. (B) Mitral annuloplasty has reestablished a smaller annulus and resulted in improved leaflet coaptation and competency. The Annals of Thoracic Surgery 2003 76, S2254-S2259DOI: (10.1016/j.athoracsur.2003.09.008)

Fig 6 (A) Jarvik 2000. (B) Jarvik 2000: preimplant (left panel); 24 hours postimplant (right panel). The Annals of Thoracic Surgery 2003 76, S2254-S2259DOI: (10.1016/j.athoracsur.2003.09.008)