RESUMEN

OBJECTIVE: The temporal response to endoventriculoplasty (EVP) has not been well defined. We have evaluated the long-term clinical and functional results of this technique. METHODS: From 1988 to 1997, 121 patients underwent aneurysmectomy by EVP associated with myocardial revascularization for anteroapical left ventricular postinfarction aneurysm. Among these, 39 patients (43%) underwent early post-operative cardiac catheterization (within 3 months maximum), and were available to be revaluated after a mean follow-up time of 56+/-28 months, by means of a new hemodynamic study. Left ventricular silhouettes were analyzed by means of a special software. RESULTS: The mean New York Heart Association functional class decreased from 2.5+/-0.9 to 1.6+/-0.8 (P<0.001) late postoperatively. The global ejection fraction improved early postoperatively from 43+/-13 to 61+/-13% (P<0.001), and late postoperatively slightly decreased to 42+/-13% (ns) versus preoperative values. Left ventricular end diastolic pressure early postoperatively fell from 16.8+/-7 to 15.7+/-6.7 (ns), and late postoperatively increased to 21.6+/-8.8 (ns) versus preoperative values. Pulmonary artery pressure rose early postoperatively from 31.5+/-6.4 to 32.1+/-6.7 (ns), and late postoperatively to 34.9+/-8.9 (ns). The global contractility score decreased early postoperatively from 42.3+/-9.6 to 28.4+/-13.6 (P<0.001); the global late postoperative contractily was 35+/-14 (ns) versus preoperative values. Patients who benefit most from the operation were those with a normal postoperative contraction pattern, where ejection fraction improved respectively early postoperatively from 43+/-13 to 63+/-11% (P<0.001), and late postoperatively to 49+/-10% (P<0.001) versus preoperative values. Occlusion or critical stenosis of bypass grafts occurred in 10 patients (25.6%). There were no significant differences in hemodynamic data and hypokinesis score changes between patients with patent or occluded bypass graft, and between patients with mono or multivessel disease. The operative mortality was 6.3%, and 8.8% needed intraaortic balloon counterpulsation. The actuarial survival rates at 5 and 7 years were 73+/-6 and 61+/-6%. The mean follow-up period was 68 months (with 112 months maximum). CONCLUSIONS: We conclude that, in our patients group, EVP of left ventricular aneurysm associated with coronary grafting improves clinical status after operation. We registered a trend for a mild hemodynamic worsening, irrespective of coronary artery disease except in those patients who had shown a normal postoperative contraction pattern.

Asunto(s)

RESUMEN

Cardiac papillary fibroelastomas are rare cardiac tumors and have been considered a 'benign' incidental finding that may have significant clinical manifestations. In this paper we report two cases of mitral valve fibroelastoma: one was discovered by chance with transthoracic echocardiography in a young healthy man, the other was an intraoperative incidental finding in a middle aged man with a recent history of acute myocardial infarction. The mitral valve was repaired in both cases after excising the tumor. The patients did well and remain asymptomatic. A literature review was compiled which comprises previous case reports of 34 patients with mitral valve papillary fibroelastomas. Most were asymptomatic, but when symptoms occurred, they could be disabling, such as stroke, cardiac heart failure, myocardial infarction, and sudden death. Papillary fibroelastoma is amenable to simple surgical excision or in addition to mitral valve repair or replacement. Recurrence has not been reported.

Asunto(s)

RESUMEN

In this study are considered the short-middle term results of anterior mitral leaflet prolapse repair obtained by means of a personal operative technique: chordal shortening and free edge remodeling. In our institution since 1993 34 consecutive patients with degenerative myxomatous mitral regurgitation, (mean age 63.3 years, range 25 to 83 years), underwent surgery. Before the operation 22 patients (64.7%) were in NYHA functional class III or IV. Mitral insufficiency, evaluated by echocardiogram, was severe in all patients; a prolapse of only anterior leaflet was present in 10 patients, both leaflets prolapsed in the others. Patients with chordal rupture of anterior mitral leaflet were excluded. Anterior mitral leaflet prolapse repair was performed with two continuous sutures including the free edge as well as the chordae for a variable length (2 mm up to 5 mm) depending on the degree of the elongation. A concomitant posterior leaflet quadrangular resection was performed in 24 patients (70.5%), and the procedure was almost always completed by a posterior suture annuloplasty reinforced by a glutaraldehyde-tanned strip of autologous pericardium. There were no perioperative deaths. The postoperative course was uneventful in all cases, and there were no hospital deaths. Postoperative echocardiographic evaluation showed satisfactory valve function. The mean valvular regurgitation before surgical procedure was 3.67 +/- 0.4, after repair 0.30 +/- 0.5 (p < 0.01). Follow-up was completed in all patients (mean 16.5 months) with no late deaths. One patient required early reoperation for recurrent mitral regurgitation resulting for a recurring anterior leaflet prolapse. We conclude that this technique is a safe, effective and easy procedure for the repair of anterior mitral leaflet prolapse without rupture. Nevertheless, a larger number of patients and a longer follow-up are required to confirm our results.

Asunto(s)

RESUMEN

This is a selected series of 28 patients with myxomatous mitral regurgitation that underwent correction of the anterior leaflet prolapse caused by chordal elongation by means of a running suture involving the chordal-cusp junction. Postoperative echocardiograms showed correction of anterior leaflet prolapse and mitral regurgitation in all patients. This technique is effective and easy to perform, and increases the number of options for restoring mitral valvular function.

Asunto(s)

Asunto(s)

RESUMEN

OBJECTIVE: A prospective angiographic study was undertaken to investigate, with an objective analysis, the global and regional wall response to myocardial revascularization. METHODS: Thirty-one patients (30 men and 1 woman, mean age, 61 years) with a left ventricular ejection fraction of less than 0.30 were admitted to our institution between 1992 and 1995 for two- or three-vessel coronary artery disease requiring myocardial revascularization. All patients underwent isolated coronary artery bypass grafting and were studied 3 months later with angiography. Preoperative and postoperative wall motion were analyzed using special software that computed a segmental left ventricular ejection fraction, generating a segmental score. Computerized analysis allowed us to distinguish patients with diffuse hypokinesis and a symmetric contraction pattern from patients with akinesis involving at least two segments and an asymmetric contraction pattern. RESULTS: There were no operative deaths and no patient required intraaortic balloon counterpulsation. One patient had postoperative enzymatic evidence of myocardial infarction. Postoperative angiography showed a graft patency rate of 84%. Global analysis showed a small but significant rise in the left ventricular ejection fraction (0.25 +/- 0.51 to 0.31 +/- 0.70, p < 0.001) and a fall in the left ventricular end-diastolic pressure (23.7 +/- 10 to 16.5 +/- 9 mm Hg, p < 0.01). Mean scores always have been lower after the operation than before it, with the best results obtained for the apex and the worst for the anterobasal segment. The group with a symmetric contraction pattern showed a trend toward a better hemodynamic response than the group with an asymmetric contraction pattern. Regression analysis revealed two important predictors of segmental functional improvement: (1) the absence of an echocardiographic scar, and (2) the presence of a collateral circulation. CONCLUSIONS: Coronary artery bypass grafting produced a small but substantial improvement in patients with ischemic cardiomyopathy. The greater benefit occurred in patients with a symmetric contraction pattern. The absence of an echocardiographic scar and the presence of a collateral circulation predicted segmental functional improvement.

Asunto(s)

RESUMEN

Mitral annuloplasty has always been a target for the cardiac surgeon, even before the era of open heart surgery. We describe here commisural annuloplasty, annular reduction with rings, and supported annular reduction without rings, which are, at the present time, the three types of annuloplasties employed. The increasing incidence of mitral valve surgery for degenerative disease suggests reconstructive surgery with autologous patients tissue as the gold standard.

Asunto(s)

RESUMEN

A case of iatrogenic aortic insufficiency due to laceration of the aortic right coronary leaflet at the time of diagnostic heart catheterization is presented. The situation was remedied by repairing the lacerated leaflet.

Asunto(s)

Asunto(s)