Severe diastolic dysfunction after endoventriculoplasty

Abstract

Endoventriculoplasty with pericardial patch has been advocated to repair anteroseptal ventricular aneurysm, but not studies have reported the influence of this technique on diastolic left ventricular function. We have evaluated the changes on ventricular filling by means of pulsed Doppler recording of diastolic transmitral flow. Doppler analysis reveals three distinct spectral patterns: (1) normal, (2) inverted, and (3) restrictive. We have found an abrupt change from a preoperative normal to postoperative restrictive pattern in a significant minority of patients (8%) who underwent endoventriculoplasty. These patients had clinical and hemodynamic signs (New York Heart Association class, time from anterior myocardial infarction, left ventricular end-diastolic pressure, pulmonary hypertension, and mitral regurgitation) of severe impairment but no differences were found in ejection fraction, aneurysmal extension, or remote myocardial function. Moreover, after operation they had a satisfactory ejection fraction, a low end-diastolic volume, and an apex-base length shorter than the predicted value for a normal population. The presence of a postoperative restrictive pattern of diastolic filling is a strong predictor of 3-month mortality and makes the medical treatment difficult. Caution must be taken to perform endoventriculoplasty in patients who are severely ill, especially those recently affected by myocardial infarction. When the clinical conditions dictate the operation, a nonenthusiastic volume reduction seems to be a prudent option.

Results of coronary artery bypass grafting alone and combined with surgical ventricular reconstruction for ischemic heart failure

“…The efficiency of SVR for classical left ventricular aneurysms was confirmed by numerous studies [8][9][10][11][12][13]. While some authors did not reveal significant difference between the results of the CABG alone and combined with SVR in patients with ischemic heart failure [1,5,14].…”

Left ventricular dimension and shape after postinfarction aneurysm repair

“…Di Donato et al [15] revealed that some changes of LV shape after the Dor procedure contribute to the enlargement of LV sphericity, because its longitudinal axis is shortened, with its diameter remaining unchanged. Salati et al [24] observed severe diastolic dysfunction of LV after endoventriculoplasty when the LV length was inappropriately reduced and the patch was too small in high-risk patients.…”

Left ventricular remodelling and outcomes after surgery: pathophysiological insights for a modern surgical approach to ischaemic cardiomyopathy

“…Acute onset of diastolic function impairment in the early postoperative period with severe clinical outcome has been reported. This impairment has been explained by the reconstruction of a too small left ventricle with lack of diastolic capacity [35]. Moreover, a delayed impairment of diastolic function has been hypothesised to explain some disappointing late results after LV reconstruction.…”

“…The hypothetical explanation is the development of a multifactorial (marked hypertrophic response, stretching, etc.) myopathy causing an abnormal wall tension with worsening of diastolic function in the nonscarred remote myocardium [13,35].…”