Preoperative modeling of an optimal left ventricle volume for surgical treatment of ventricular aneurysms

Objective: We evaluated the results of surgical treatment postinfarction ve ntricular aneurysms, with preoperative modeling of an optimal left ventricl e volume. Methods: From January 1998 to December 2000, 41 patients underwen t left ventricular (LV) aneurysm repair. There were 39 men and two women, w ith a mean age 45.6 +/- 6.2 years. With echocardiography study, an optimal end-diastolic volume of LV was modeled on the basis of the proper stroke in dex and the contractile ejection fraction (EF). A permissible area of aneur ysm resection was calculated by using a difference between the initial and the projected surface area of LV. The patch position and sizes were measure d preoperatively. Ventricular reconstruction was performed by using linear plasty in eight patients, septal plasty of the Stoney et al. technique in 1 4 patients, and endoventriculoplasty of the Dor et al. technique in 19 pati ents. Results: The mean NYHA functional class decreased from 2.9 +/- 0.6 to 1.6 +/- 0.7 postoperatively. The improvement of LV contracting function ma de itself evident in a decreased end-diastolic volume from 216 +/- 98 to 15 8 +/- 35 ml, and end-systolic volume from 133 +/- 85 to 80 +/- 34 ml postop eratively. The mean EF increased from 38 +/- 11 to 49 +/- 9% after operatio n. We noted that preoperative contractile EF corresponded with postoperativ e EF (49.8 +/- 11% and 49.3 +/- 9%, respectively), The projected optimal en d-diastolic volume of LV estimated before operation agreed with postoperati ve data (152 +/- 33 ml and 158 +/- 35 ml, respectively). The hospital morta lity rate was 7.3%. Conclusions: Preoperative modeling of an optimal LV vol ume allows for the estimation of a permissible area of aneurysm resection, the position and sizes of the patch, as well as for the prevention of an ex cessive reduction of the LV cavity after aneurysm repair. (C) 2001 Elsevier Science B.V. All rights reserved.