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  • 1
    Electronic Resource
    Electronic Resource
    Mitral Regurgitation After Partial Left Ventriculectomy As the Cause of Ventricular Redilatation (2001)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 16 (2001), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: It remains unclear whether ventricular redilatation after partial left ventriculectomy (PLV) is due to underlying pathology or to continued volume overload amenable to surgery. Methods: Among patients undergoing PLV, 32 had Doppler echocardiography preoperatively, immediately after surgery (〉 1 week), early after surgery (1–3 months), and late after surgery (8–14 months). Patients were divided into groups with mitral regurgitation (MR; MR+, n = 16) and without postoperative MR (MR-, n = 16) and were compared for ventricular size, performance, and survival. Results: After initial surgical reduction, left ventricular dimension on average gradually increased back to the preoperative level in subgroups of patients with valvular disease and cardiomyopathy and in all patients combined. Most patients showed drastically reduced left ventricular dimension early after PLV. In MR+ patients, dimension increased back to the preoperative level within 3 months after surgery, whereas the MR- group maintained reduced dimension throughout the first year in all patients combined and in a subgroup of patients with cardiomyopathy. Occurrence of significant MR after PLV appeared to be related to severity of fibrosis in excised myocardium but not to severity of preexisting MR, etiology, or performance of mitral valvuloplasty. Conclusions: Early postoperative MR, residual or new, appeared to play an important role in dictating early hemodynamics and late outcome in patients undergoing PLV. Results suggest an aggressive simultaneous approach to abolish MR. Causative role of myocardial fibrosis remains unclear and needs further study.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.2001.tb00492.x
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  • 2
    Electronic Resource
    Electronic Resource
    Perioperative Ventricular Arrhythmias in Patients Undergoing Partial Left Ventriculectomy (2001)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 16 (2001), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Although incidence of ventricular arrhythmias after partial left ventriculectomy (PLV) has been reported, there are no studies comparing incidence before and after PLV. Although operative scars may give rise to arrhythmias, improved energetic efficiency after PLV may decrease their incidence. Methods: Pre- and postoperative ventricular arrhythmias were monitored by Holter ECG and analyzed in 17 patients undergoing PLV in Curitiba, Brazil. Results: Although total 24-hour heart beat (THB) increased significantly (p = 0.018), ventricular premature contractions (VPCs) decreased markedly (p = 0.036), excluding one patient dying in low cardiac output (LOS) who had terminal arrhythmias increased multifold. In the remaining 16 patients, VPC pairs were also reduced significantly on the average (p = 0.038). In contrast, ventricular tachycardia (VT; more than three consecutive VPCs) disappeared in five patients, decreased in two patients, and newly occurred in four patients, with five patients showing no change; one of them developed a prolonged VT, successfully reversed by external cardioversion. Conclusions: Despite notable significant increase in THB immediately after PLV, PVC and PVC pairs were significantly decreased in contrast to VT, which disappeared in some patients and newly occurred in other patients, remaining constant on the average. Sustained VT occurring in a patient with all other arrhythmias suppressed may suggest a unique electrophysiological substrate, may justify prophylactic use of amiodarone or an implantable cardioverter-defibrillator, and may underscore the importance of further and extended studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.2001.tb00493.x
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  • 3
    Electronic Resource
    Electronic Resource
    Transeventricular Mitral Annuloplasty in a Patient Undergoing Partial Left Ventriculectormy (2001)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 16 (2001), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A 70-year-old male patient with heart failure resulting from dilated cardiomyopathy underwent a partial left ventriculectomy between the papillary muscles and a newly devised transventricular mitral annuloplasty. Intraoperative transesophageal Doppler echocardiography revealed reduced ventricular dimensions and corrected mitral insufficiency with unchanged ventricular filling patterns, allowing prompt recovery despite unchanged myocardial pathology.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.2001.tb00499.x
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  • 4
    Electronic Resource
    Electronic Resource
    Partial Left Ventriculectomy for Patients with Ischemic Cardiomyopathy (2001)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 16 (2001), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Partial left ventriculectomy (PLV) has been performed in patients with dilated cardiomyopathy (DCM), but improved myocardial energetics may make PLV useful also for ischemic cardiomyopathy (ICM) unamenablis to conventional treatment. Methods: Of 262 patients undergoing PLV, 94 patients with ICM as the underlying pathology were analyzed and compared with 168 patients with DCM. Results: ICM patients were older (57.3 years vs 50.9 years, p = 0.0001) and heavier (69.7 kg vs 65.9 kg, p = 0.039) than those with DCM, but ventricular end-diastolic and end-systolic dimensions were similar with comparably depressed fractional shortening (16% vs 15%, p = 0.294) and equally severe functional limitation [New York Heart Association (NYHA) Class 3.7 vs 3.6, p = 0.734]. A majority of patients in both groups underwent lateral PLV (76% vs 74%, p = 0.883) with myocardium excised between papillary muscles and simultaneous mitral valvuloplasty (41% vs 74%, p 〈 0.0001). Because ICM patients required coronary artery bypass grafting (CABG) more frequently (79% vs 0.6%, p 〈 0.0001), operation was more extensive in terms of bypass time (74 minutes vs 47 minutes, p 〈 0.0001), percentage requiring cardiac arrest (43% vs 19%, p 〈 0.0001), and arrest duration (34 minutes vs 28 minutes, p = 0.280), but all had similar resection and postoperative ventricular dimensions. Nonetheless, ICM patients required shorter intensive care unit (ICU) time (4.4 days vs 5.9 days, p = 0.048) and similar postoperative hospital stays, resulting in similar hospital survival rates (69% vs 71%, p = 0.778) and functional capacity in long-term follow-up. Conclusions: Results suggest that PLV can be performed in patients with ICM with comparable risks and benefits as in DCM. Relative efficacy of CABG and mitral repair as compared to volume reduction remains to be studied.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.2001.tb00500.x
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  • 5
    Electronic Resource
    Electronic Resource
    Immediate Effects of Partial Left Ventriculectomy on Left Ventricular Function (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 13 (1998), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract Background: Attempts to prolong life or to improve the quality of life by partial left ventriculectomy in patients suffering from dilated cardiomyopathy have yielded strikingly variable results in leading surgical centers. Hypothesis: The outcome of patients after partiat left ventriculectomy depends on intraoperative myocardial protection together with appropriate long-term pharmacotherapy. We further assume that partial removal of the fibrotic ventricular wall may lead to a particularly inhomogeneous pattern of wall stress, giving rise to the potential of a paradoxical increase in wall stress and the creation of arrhythmogenic foci. Methods: During surgery in 24 patients, local mesh tension was measured using needle-force probes in up to five sites within the left ventricular wall before and after resection of the interpapillary mural segment. The data were used to calculate regional peak developed force and to identify any differences in the timing of local mechanical activity between the measured regions. Results: Mean decrease in regional wall stress was 42% (76 sites of measurement). However, we discovered a paradoxicat increase of 42% in 18 sites of measurement. The time delay in the onset of force development between the measured regions prior to surgery was 0 msec in 10 patients, up to 30 msec in 7 patients, and beyond 80 msec in 7 patients. After resection, the time delay increased considerably in incidence and duration. Conclusion: Ventriculectomy is an effective means of reducing wall stress. The unexpectedly high incidence of inhomogeneities in wall stress after asymmetrical surgical ventricular remodeling, currently typical for the classical Batista procedure, together with the asynchronous regional ventricular function that we found to increase after partial left ventriculectomy, needs further elucidation by electrophysiological investigations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1998.tb01082.x
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