Surgical Treatment for Patients with Coronary Heart Disease and Ventricular Aneurysm_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Yan , SUN Hansong , HU Shengshou , PAN Shiwei , TANG Yue , WANG Wei , XU Jianping.

State Key Laboratory of Cardiovascular Disease，Department of Adult Cardiac Surgery，Fu Wai Hospital，National Center for Cardiovascular Diseases，Chinese Academy of Medical Sciences and Peking Union Medical College，Beijing 100037，P. R. China;

Corresponding author：

Keywords：

Ventricular aneurysm; 　Surgery; 　Coronary artery bypass grafting

DOI：

10.7507/1007-4848.20130128

Video：

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Objective　To summarize clinical characteristics and treatment results of adult patients with coronary heart disease and ventricular aneurysm，and evaluate surgical outcomes. Methods Clinical data of 86 adult patients with coronary heart disease and ventricular aneurysm who underwent surgical treatment in Fu Wai Hospital from January 2011 to November 2012 were retrospectively analyzed. There were 70 male and 16 female patients with their average age of 57.7±10.6 years and average body weight of 71.7±10.5 kg. Preoperative echocardiography or left ventriculography showed left ventricular thrombus in 22 patients. Coronary angiography showed 47 patients with 3 vessel disease，29 patientswith 2 vessel disease，and 10 patients with single vessel disease. Sixteen patients underwent direct linear suturing of theaneurysm off pump，39 patients underwent simple linear suturing under cardiopulmonary bypass，15 patients received endoventricular purse-string reconstruction，and 16 patients received endoventricular purse-string reconstruction and patch plasty. Three patients underwent reexploration for bleeding. Sixty-four patients received concomitant coronary artery bypass grafting（CABG）. Results Postoperatively 2 patients（2.3%） died of refractory ventricular fibrillation and multiple organ dysfunction syndrome respectively. Patients undergoing concomitant CABG received 2.3±1.2 grafts on the average. Seventy-eightpatients （92.9%） were followed up for 2-24 months after discharge. During follow-up，patients’ angina symptoms significantlyresolved，heart function improved in varying degrees，and no new sign of myocardial ischemia was found on electrocardiogram.Left ventricular ejection fraction （LVEF） was significantly higher than preoperative LVEF（51%±7% vs. 41%±9% ，t=6.20，P=0.00），and left ventricular end-diastolic diameter （LVEDD） was significantly smaller than preoperative LVEDD （54.2±6.2 mm vs. 56.0±6.8 mm，t=4.60，P=0.00） . Conclusion Ventricular aneurysm repair and concomitant CABG （or ventricular septal perforation repair，mitral valvuloplasty et al） are positive and effective treatment strategies for postinfarction ventricular aneurysm. Satisfactory clinical outcomes can be achieved by individualized treatment based on appropriate surgical strategies according to the size of ventricular aneurysm.

Citation： ZHANG Yan,SUN Hansong,HU Shengshou,PAN Shiwei,TANG Yue,WANG Wei,XU Jianping.. Surgical Treatment for Patients with Coronary Heart Disease and Ventricular Aneurysm. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(4): 410-413. doi: 10.7507/1007-4848.20130128 Copy

1.	Sutton MG， Sharpe N. Left ventricular remodeling after myocardial infarction：pathophysiology and therapy. Circulation， 2000， 101 (25)：2981-2988.
2.	Starling RC， McCarthy PM， Yamani MH. Surgical treatment of chronic congestive heart failure. In：Mann DL. Heart Failure：a comp-anion to Braunwald’s Heart disease. Philadelphia：Saunders， 2004. 717-736.
3.	Nardi P， Pellegrino A， Scafuri A， et al. Long-term outcomes aftersurgical ventricular restoration and coronary artery bypass graftingin patients with postinfarction left ventricular anterior aneurysm. J Cardiovasc Med， 2010， 11(2)：96-102.
4.	Calafiore AM， Iacò AL， Abukoudair W， et al. Left ventricular surgical remodeling after the STICH trial. Thorac Cardiovasc Surg， 2011， 59(4)：195-200.
5.	Shudo Y， Taniguchi K， Takeda K， et al. Restrictive mitral annulo-plasty with or without surgical ventricular restoration in ischemicdilated cardiomyopathy with severe mitral regurgitation. Circulation，2011， 124(11 Suppl)：s107-s114.
6.	Likoff W， Bailey CP. Ventriculoplasty：excision of myocardialaneurysm. Report of a successful case. JAMA， 1955， 158：915-920.
7.	Cooley DA， Collins HA， Morris GC Jr， et al. Ventricular aneurysm after myocardial infarction：surgical excision with use of temporary cardiopulmonary bypass. J Am Med Assoc， 1958， 167(5)：557-560.
8.	Jatene AD. Left ventricular aneurysmectomy. Resection or reconst-ruction. J Thorac Cardiovasc Surg， 1985， 89(3)：321-331.
9.	Dor V， Saab M， Coste P， et al. Left ventricular aneurysm：a new surgical approach. Thorac Cardiovasc Surg， 1989， 37(1)：11-19.
10.	Cooley DA. Ventricular endoaneurysmorrhaphy：a simplified repair for extensive postinfarction aneurysm. J Card Surg， 1989， 4(3)：200-205.
11.	李浩杰，宋云虎，胡盛寿，等. 实时三维超声评价左室室壁瘤外科治疗后左心室局部收缩功能的改变. 中国胸心血管外科临床杂志， 2011， 18(3)：209-213.
12.	谷天祥，房勤，喻磊，等. 心肌梗死后室壁瘤及二尖瓣反流的外科治疗. 中国胸心血管外科临床杂志， 2008， 15(5)：325-328.
13.	Praeger PI， Praeger JA， Lee LY. Off-pump plication of left ventri-cular aneurysm. Ann Thorac Surg， 2011， 92(4)：1514-1516.
14.	董然，陈宝田，刘韬帅，等. 非体外及体外循环下左心室运动异常型室壁瘤切除术的临床疗效比较. 中国胸心血管外科临床杂志， 2009， 16(6)：421-425.
15.	肖巍，张健群，孔晴宇，等. 非体外循环心脏不停跳冠状动脉旁路移植术加左心室室壁瘤折叠术的临床效果. 中国胸心血管外科临床杂志， 2013， 20(1)：20-23.
16.	Huang XS， Gu CX， Yang JF， et al. Off-pump anteroapical aneurysmplication for left ventricular post-infarction aneurysm：long-termresults. Chin Med J (Engl)， 2012， 125(18)：3228-3235.
17.	Chen X， Qiu ZB， Xu M， et al. Surgery for left ventricular aneurysm after myocardial infarction：techniques selection and results assessment.Chin Med J (Engl)， 2012， 125(24)：4373-4379.
18.	Parachuri VR， Adhyapak SM， Kumar P， et al. Ventricular restorationby linear endoventricular patchplasty and linear repair. Asian CardiovascThorac Ann， 2008， 16(5)：401-406.
19.	Wang X， He X， Mei Y， et al. Early results after surgical treatment of left ventricular aneurysm. J Cardiothorac Surg， 2012， 7：126.
20.	Altay H， Altin C， Coner A， et al. Normal coronary artery patientpresenting with left ventricular aneurysm. Case Rep Med， 2011， 2011：183050.
21.	Tekümit H， Polat A， Uyar I， et al. Left ventricular aneurysm usingthe Dor technique：mid-term results. J Card Surg， 2010， 25(2)：147-152.
22.	Coskun KO， Popov AF， Coskun ST， et al. Surgical treatment of left ventricular aneurysm. Asian Cardiovasc Thorac Ann， 2009， 17(5)：490-493.
23.	Chen WY， Wu FY， Shih CC， et al. Left ventricular aneurysm repair：a comparison of linear versus patch remodeling. J Chin Med Assoc， 2009， 72(8)：414-421.
24.	Zheng Z， Fan HG， Feng W， et al. Surgery of left ventricular aneurysm：a propensity score-matched study of outcomes following differentrepair techniques. Interact Cardiovasc Thorac Surg， 2009， 9(3)：431-436.
25.	Daneshmand M， Milano CA. Surgical treatments for advanced heartfailure. Surg Clin North Am， 2009， 89(4)：967-999.

1. 　Sutton MG， Sharpe N. Left ventricular remodeling after myocardial infarction：pathophysiology and therapy. Circulation， 2000， 101 (25)：2981-2988.
2. 　Starling RC， McCarthy PM， Yamani MH. Surgical treatment of chronic congestive heart failure. In：Mann DL. Heart Failure：a comp-anion to Braunwald’s Heart disease. Philadelphia：Saunders， 2004. 717-736.
3. 　Nardi P， Pellegrino A， Scafuri A， et al. Long-term outcomes aftersurgical ventricular restoration and coronary artery bypass graftingin patients with postinfarction left ventricular anterior aneurysm. J Cardiovasc Med， 2010， 11(2)：96-102.
4. 　Calafiore AM， Iacò AL， Abukoudair W， et al. Left ventricular surgical remodeling after the STICH trial. Thorac Cardiovasc Surg， 2011， 59(4)：195-200.
5. 　Shudo Y， Taniguchi K， Takeda K， et al. Restrictive mitral annulo-plasty with or without surgical ventricular restoration in ischemicdilated cardiomyopathy with severe mitral regurgitation. Circulation，2011， 124(11 Suppl)：s107-s114.
6. 　Likoff W， Bailey CP. Ventriculoplasty：excision of myocardialaneurysm. Report of a successful case. JAMA， 1955， 158：915-920.
7. 　Cooley DA， Collins HA， Morris GC Jr， et al. Ventricular aneurysm after myocardial infarction：surgical excision with use of temporary cardiopulmonary bypass. J Am Med Assoc， 1958， 167(5)：557-560.
8. 　Jatene AD. Left ventricular aneurysmectomy. Resection or reconst-ruction. J Thorac Cardiovasc Surg， 1985， 89(3)：321-331.
9. 　Dor V， Saab M， Coste P， et al. Left ventricular aneurysm：a new surgical approach. Thorac Cardiovasc Surg， 1989， 37(1)：11-19.
10. 　Cooley DA. Ventricular endoaneurysmorrhaphy：a simplified repair for extensive postinfarction aneurysm. J Card Surg， 1989， 4(3)：200-205.
11. 　李浩杰，宋云虎，胡盛寿，等. 实时三维超声评价左室室壁瘤外科治疗后左心室局部收缩功能的改变. 中国胸心血管外科临床杂志， 2011， 18(3)：209-213.
12. 　谷天祥，房勤，喻磊，等. 心肌梗死后室壁瘤及二尖瓣反流的外科治疗. 中国胸心血管外科临床杂志， 2008， 15(5)：325-328.
13. 　Praeger PI， Praeger JA， Lee LY. Off-pump plication of left ventri-cular aneurysm. Ann Thorac Surg， 2011， 92(4)：1514-1516.
14. 　董然，陈宝田，刘韬帅，等. 非体外及体外循环下左心室运动异常型室壁瘤切除术的临床疗效比较. 中国胸心血管外科临床杂志， 2009， 16(6)：421-425.
15. 　肖巍，张健群，孔晴宇，等. 非体外循环心脏不停跳冠状动脉旁路移植术加左心室室壁瘤折叠术的临床效果. 中国胸心血管外科临床杂志， 2013， 20(1)：20-23.
16. 　Huang XS， Gu CX， Yang JF， et al. Off-pump anteroapical aneurysmplication for left ventricular post-infarction aneurysm：long-termresults. Chin Med J (Engl)， 2012， 125(18)：3228-3235.
17. 　Chen X， Qiu ZB， Xu M， et al. Surgery for left ventricular aneurysm after myocardial infarction：techniques selection and results assessment.Chin Med J (Engl)， 2012， 125(24)：4373-4379.
18. 　Parachuri VR， Adhyapak SM， Kumar P， et al. Ventricular restorationby linear endoventricular patchplasty and linear repair. Asian CardiovascThorac Ann， 2008， 16(5)：401-406.
19. 　Wang X， He X， Mei Y， et al. Early results after surgical treatment of left ventricular aneurysm. J Cardiothorac Surg， 2012， 7：126.
20. 　Altay H， Altin C， Coner A， et al. Normal coronary artery patientpresenting with left ventricular aneurysm. Case Rep Med， 2011， 2011：183050.
21. 　Tekümit H， Polat A， Uyar I， et al. Left ventricular aneurysm usingthe Dor technique：mid-term results. J Card Surg， 2010， 25(2)：147-152.
22. 　Coskun KO， Popov AF， Coskun ST， et al. Surgical treatment of left ventricular aneurysm. Asian Cardiovasc Thorac Ann， 2009， 17(5)：490-493.
23. 　Chen WY， Wu FY， Shih CC， et al. Left ventricular aneurysm repair：a comparison of linear versus patch remodeling. J Chin Med Assoc， 2009， 72(8)：414-421.
24. 　Zheng Z， Fan HG， Feng W， et al. Surgery of left ventricular aneurysm：a propensity score-matched study of outcomes following differentrepair techniques. Interact Cardiovasc Thorac Surg， 2009， 9(3)：431-436.
25. 　Daneshmand M， Milano CA. Surgical treatments for advanced heartfailure. Surg Clin North Am， 2009， 89(4)：967-999.

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Surgical Treatment for Patients with Coronary Heart Disease and Ventricular Aneurysm

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