Left Ventricular Performance before and after Removal of the Noncontractile Area of the Left Ventricle and Revascularization of the Myocardium

Abstract

The left ventricular volume and the internal surface areas of noncontractile regions were measured by cineangiocardiography at 60 frames/sec in nine patients with a chronic localized noncontractile area of the left ventricle. Arteriosclerotic heart disease was proven in eight patients by means of coronary arteriography. Left ventricular end-diastolic pressure, stroke volume, ejection fraction, mean circumferential shortening, and cardiac output were also measured before and after removal of the noncontractile area and revascularization of the myocardium.The noncontractile areas, measured at end-diastole, ranged from 12 to 40% of the intemal surface area of the left ventricle. Generally, impairment of the left ventricular function depended on the size of the noncontractile areas. The end-diastolic volume was approximately 150 ml/m2 when the size of noncontractile areas exceeded 20-25% of the left ventricular surface area (r = +0.72; P < 0.05). The ejection fraction decreased as the size of the noncontractile areas increased (r =-0.81; P < 0.01). Following surgery, the left ventricular function, as well as the clinical condition, improved significantly, although the cardiac performance remained in the abnormal range in most patients. The ejection fraction increased (P < 0.05), and the percent circumferential shortening also improved (P < 0.05).Removal of the noncontractile area of the left ventricle and revascularization of the myocardium improved the cardiac performance and increased the sense of well being in these patients.

Correlation of ejection fraction and infarct size estimated from the total CK released in patients with acute myocardial infarction.

“…We showed that the extent of the akinetic or dyskinetic segment was closely correlated with left ventricular ejection fraction (r = -0 80, see Fig. 4) and this was consistent with the experience of other authors (Feild et al, 1972;Kitamura et al, 1972;Rogers etal., 1977). Furthermore, it is interesting that the total CK released closely correlated with the ejection fraction, as Rogers et al (1977) have recently reported (anterior infarction: r = -0 71, P < 0 01; inferior infarction: r = -0 73, P < 0-01).…”

Long-term results after left ventricular aneurysmectomy.

“…The results of aneurysmectomy in our patients are in accord with other studies, namely striking clinical improvement2-5 7 8 17 and reduction of the radiologically estimated heart volume.14 The angiographic finding of a residual aneurysm in 70 per cent of our patients and akinesia in the remainder is also in keeping with the observations of others.4 5 It seems obvious that the area of the suture line with Teflon pledgets will be akinetic, and the presence of a residual aneurysm probably reflects non-excised, more or less fibrotic tissue which is left deliberately as support for sutures. Kitamura et al5 found the excised non-contractile area to be smaller than that estimated in the preoperative angiograms.…”

Failure of aneurysmectomy to improve left ventricular function.

“…Studies comparing ventricular function by cineangiography before and after aneurysmectomy are rare. Kitamura et al (1972) reported a series of 9 patients who underwent aneurysmectomy associated with aortocoronary bypass surgery in 4 patients and internal mammary implants in the remaining 5 patients. The ejection fraction in their series improved from 31 to 44 per cent but remained severely depressed after surgery.…”