LEFT-VENTRICULAR GEOMETRY AFTER ENDOVENTRICULOPLASTY

From 1988 to 1992, 65 patients underwent endoventriculoplasty (EVP) fo r anteroapical left ventricular aneurysm. The operative mortality was 4.6%, and 9.2% needed intraaortic balloon counterpulsation (IABP). For ty-three patients were restudied by ventriculography and the preoperat ive and postoperative silhouettes were analyzed by means of a special computer program. In 24 patients computerized analysis showed a restor ed left ventricular (LV) geometry with symmetrical contraction pattern and a contractile apical segment. Residual deformity of the LV chambe r associated with an asymmetrical contraction pattern was present in 1 9 cases. Data from these 43 patients were analyzed to detect predictiv e factors for successful heart geometry reconstruction. Univariate ana lysis revealed that the preoperative ejection fraction, global contrac tion score, and a non-aneurysmatic segments contraction score did not determine successful reconstruction. The presence of a preserved proxi mal septum (2.5 cm or more) on echocardiography was the only significa nt predictor. We would recommend liberal use of the EVP technique in p atients with anteroapical LV aneurysm and preserved proximal septum in order to restore satisfactory LV geometry with a low operative risk. Caution must be taken when performing EVP in patients with fibrotic pr oximal septum.