Early and late results of left ventricular reconstruction in thin-walled chambers: Is this our patient population? Gerald D. Buckberg, MD The Journal.

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Presentation transcript:

Early and late results of left ventricular reconstruction in thin-walled chambers: Is this our patient population? Gerald D. Buckberg, MD The Journal of Thoracic and Cardiovascular Surgery Volume 128, Issue 1, Pages 21-26 (July 2004) DOI: 10.1016/j.jtcvs.2004.03.009

Figure 1 A, Dyskinetic heart contrasts thick-walled conic chamber within silhouette with outer, thin, aneurysmal segment, reflecting scar after infarction without reperfusion. B, Muscle becomes akinetic as reperfusion reduces necrosis to damage inner and middle left ventricular walls, leaving salvaged epicardial surface. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 21-26DOI: (10.1016/j.jtcvs.2004.03.009)

Figure 2 A, Dyskinetic muscle is seen in image taken in 1993, where end systole shows large anterior septal infarction. Ejection fraction is 37% because of good contraction of remote muscle. B, Image taken in 2000 shows development of global akinesia from increased end-systolic volume. This change occurred despite lack of progression of coronary disease. Infarct region did not change, but remote muscle progressively dilated to reduce ejection fraction to 14%. See online video. Images provided by Dor. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 21-26DOI: (10.1016/j.jtcvs.2004.03.009)

Figure 3 Ventricular cross-sections showing necrosis of inner and middle shells of anterolateral wall after ischemia and reperfusion (arrows). A, Changes are seen by triphenyl tetrazolium staining. B, Changes are seen by hyperenhancement by gadolinium scan during MRI analysis. Images provided by Judd from Northwestern University. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 21-26DOI: (10.1016/j.jtcvs.2004.03.009)

Figure 4 A, MRI tracing (seen by online video) shows akinesia of anterolateral wall. B, Gadolinium scan on MRI analysis. Thickened muscle with delayed hyperenhancement shows necrosis of 64% of dilated muscle mass. This nonfunctional but full-thickness region caused CHF and does not collapse during ventricular venting. Images provided by Kim from Northwestern University. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 21-26DOI: (10.1016/j.jtcvs.2004.03.009)

Figure 5 Trabecular muscle of nonfunctional anterolateral wall has no scar. In beating state, palpation is used to exclude this region, as shown by video. There is no transmural scar. Damaged muscle could not have been differentiated if cardioplegia was used because of normal surface color and trabecular architectural pattern. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 21-26DOI: (10.1016/j.jtcvs.2004.03.009)