Spherical dilatation of the apex in failing left ventricles: a target for surgical remodelling techniques

AIM

The present study investigates the geometry of failing left ventricles with a special focus on apical deformation. A new surgical remodelling technique is evaluated.

METHODS

In 124 patients with impaired left ventricular function (EF<40%) undergoing coronary artery bypass grafting (CABG) left ventricular (LV) geometry was evaluated by MRI scanning before and after surgery. Besides the sphericity index (SI) two further indices were calculated, longitudinal EF (LEF) and an apical conicity index (ACI). The results were compared to 15 patients with coronary heart disease and normal LV function and 10 test persons. In 35 patients with impaired LV function perpendicular apical compression (AC) stitches were placed.

RESULTS

In failing left ventricles indexed LV length increased (5.3 ± 0.6 cm/m2 vs. 4.7 ± 0.8 cm/m2 in control patients and 4.6 ± 0.3 cm/m2 in test persons, P=0.03). LEF was reduced (6% ± 4 versus 22% ± 6 and 19% ± 7 P=0.04). The classical SI was 0.56 ± 0.06 in heart failure patients, 0.50 ± 0.05 in control patients and 0.48 ± 0.04 in test persons. The ACI were 0.75 ± 0.06, 0.58 ± 0.06 and 0.57 ± 0.04 respectively (P<0.05), indicating a pronounced dilatation at the apex. After apical compression LEF improved to 15 ± 1%, the ACI to 0.64 ± 0.04 (P=0.04). LVEDV (166 ± 11 mL [AC] vs. 196 ± 14 mL [without AC]) as well as LV-EF (48 ± 3% [AC] vs. 36 ± 2% [without AC]) significantly improved only after remodelling (P<0.05).

CONCLUSION

Apical compression improved ventricular geometry and ventricular function in patients with dialatation of the left ventricular apex.

Acute dissection of the left anterior descending after contusio cordis

Traumatic coronary artery dissection after blunt chest trauma is extremely rare. The diagnosis is often delayed and some are only diagnosed postmortem. We report a case of acute dissection of the left anterior descending (LAD) after contusio cordis that presented at our institution. In our case we performed the off pump coronary artery bypass operation (OPCAB) procedure with left internal mammary artery (LIMA) on LAD by a partial lower sternotomy approach. There were no operative or perioperative complications and the patient was discharged from hospital 6 days postoperatively. OPCAB operation through the partial lower sternotomy is a safe and effective technique for the treatment of patients with acute dissection of a coronary artery after blunt chest trauma.