1. Septal reshaping for exclusion of anteroseptal dyskinetic or akinetic areas 
Antonio M Calafiore, MD, Michele Di Mauro, MD, Gabriele Di Giammarco, MD, Sabina Gallina, MD, Angela L Iacò, MD, Marco Contini, MD, Antonio Bivona, MD, Stefano Volpe, MD 
The Annals of Thoracic Surgery 
Volume 77, Issue 6, Pages (June 2004)
DOI: /j.athoracsur

2. Fig 1
(A). From inside, an oblique linear suture with interrupted U stitches (Ti-cron 2/0) joins the anterior wall to the septum, starting as high as possible and following the border of the scars. (B). Intraoperative view: the suture line is stopped when it is arrived roughly at the level of the papillary muscles (2 U stitches are generally enough).
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )

3. Fig 2
Four stitches are positioned, in the septum at the end of the last interrupted suture (1), at the level of the new apex (2), deep in the septum (3), at the border between the scar and the healthy posterior septum, and in the anterior wall, again at the limit of the scar (4).
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )

4. Fig 3
Intraoperative view. An oval Dacron patch is tailored and fixed with the four stitches previously placed.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )

5. Fig 4
Intraoperative view. The patch is sutured among the septum, the anterior wall, and the new apex.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )

6. Fig 5
Perioperative transesophageal echocardiography. Before the operation, the distal septum is dyskinetic and the apex widened (A diastole, B systole). At the end of the procedure, the linear suture and the patch divide the left ventricular cavity into two portions, the real and the excluded cavities (C diastole, D systole). Four weeks after surgery the excluded cavity is clotted (E, systole).
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )