SEVERE DIASTOLIC DYSFUNCTION AFTER ENDOVENTRICULOPLASTY

Endoventriculoplasty with pericardial patch has been advocated to repa ir anteroseptal ventricular aneurysm, but no studies have reported the influence of this technique on diastolic left ventricular function, W e have evaluated the changes on ventricular filling by means of pulsed Doppler recording of diastolic transmitral flow, Doppler analysis rev eals three distinct spectral patterns: (1) normal, (2) inverted, and ( 3) restrictive. We have found an abrupt change from a preoperative nor mal to postoperative restrictive pattern in a significant minority of patients (8%) who underwent endoventriculoplasty. These patients had c linical and hemodynamic signs (New York Heart Association class, time from anterior myocardial infarction, left ventricular end-diastolic pr essure, pulmonary hypertension, and mitral regurgitation) of severe im pairment but no differences were found in ejection fraction, aneurysma l extension, or remote myocardial function, Moreover, after operation they had a satisfactory ejection fraction, a low end-diastolic volume, and an apex-base length shorter than the predicted value for a normal population. The presence of a postoperative restrictive pattern of di astolic filling is a strong predictor of 3-month mortality and makes t he medical treatment difficult. Caution must be taken to perform endov entriculoplasty in patients who are severely ill, especially those rec ently affected by myocardial infarction, When the clinical conditions dictate the operation, a nonenthusiastic volume reduction seems to be a prudent option.