Patch Repair for a Subepicardial Aneurysm With an Approach From Inside the Heart Yoshitaka Yamane, MD, Shogo Mukai, MD, Hironobu Morimoto, MD, Hiroshi.

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Presentation transcript:

Patch Repair for a Subepicardial Aneurysm With an Approach From Inside the Heart Yoshitaka Yamane, MD, Shogo Mukai, MD, Hironobu Morimoto, MD, Hiroshi Koshiyama, MD, Shuhei Okubo, MD The Annals of Thoracic Surgery Volume 100, Issue 5, Pages 1905-1907 (November 2015) DOI: 10.1016/j.athoracsur.2014.12.095 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Left ventriculographic view on arrival. The right anterior oblique view shows a burrow in the inferior wall (white arrow). Extravasation of contrast material into the extracardiac space is not seen. The Annals of Thoracic Surgery 2015 100, 1905-1907DOI: (10.1016/j.athoracsur.2014.12.095) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Transesophageal echocardiography on the next day after AMI. White arrow depicts abrupt interruption of the inferior left ventricular wall leading into a saccular aneurysm through a narrow neck. The Annals of Thoracic Surgery 2015 100, 1905-1907DOI: (10.1016/j.athoracsur.2014.12.095) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Computed tomographic view after 23 days shows expansion of the aneurysm, with the maximal diameter increasing to 30 mm. The walls of the aneurysm are thin and abut on the epicardium. External expansion does not occur. The Annals of Thoracic Surgery 2015 100, 1905-1907DOI: (10.1016/j.athoracsur.2014.12.095) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) Surgical approach. Orifice of the subepicardial aneurysm is located in the lateral proximity of the papillary muscle. (B) Schematic illustration of our surgical approach: 9 mattress sutures of polypropylene felt pledget were passed through the firm myocardial lip, and an appropriate-size bovine pericardial patch was inserted to cover the defect. The Annals of Thoracic Surgery 2015 100, 1905-1907DOI: (10.1016/j.athoracsur.2014.12.095) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions