Cardiosurgery: Left ventricular aneurysm — Cabg and plastic repair of left ventricular aneurysm. Treatment
Left ventricular aneurysm (LVA) is one of the most frequent complications of extensive myocardial infarction. According to statistics, LVA develops is almost 40% of these patients. Aneurysm is thinning of the heart wall section, which loses its ability to contract. Chronic aneurysm wall is a bulging scar tissue, while a thrombotic clot is formed in the resulting "sack" in almost half of patients.
The acute LVA is not an absolute indication for surgical correction. Emergency surgery is required in a situation of progressive heart failure and the threat of aneurysm rupture.
The presence of a chronic LVA increases the risk of thromboembolism and worsens the ischemic heart disease progression, so in most cases the patients are indicated a scheduled surgery. In the preoperative period, the conservative therapy is prescribed to stabilize the patient's condition, i.e. cardiac glycosides, antithrombotic agents, oxygen inhalation, and antihypertensives.
LVA plastics is often combined with revascularization, i.e. restoration of coronary arteries to improve the cardiac blood circulation and prevent the attacks of ischemia. Depending on the location of the aneurysm and its diameter, the professional selects one of the existing methods of plastics, based on the best expected forecast for a given patient. The plastic heart surgeries carried out subject to heart switching off, using the cardiopulmonary bypass and hypothermia. The intracardiac thrombus discovered during surgery is removed.
- Linear plastics is performed rarely and can be used for aneurysms with a small radius. The surgery implies excision of the scar tissue and linear suturing of the formed defect.
- Purse-string plastics can be used for small aneurysm located on the apex of the heart. After aneurysm excision, the opening is sutured with a purse-string (circular) suture.
- Patch plastics implies removal of the diseased tissue of the left ventricle and closing the defect with a patch made of synthetic materials or xenopericardium. The most common technique is endoventricular, upon which the patch is sewn from the inside, from the side of endocardium. Such tactics allows reducing the risk of pericardial adhesions.
The adequately chosen method of LVA plastics and surgery performance by an experienced heart surgeon in a modern specialized center allows counting on a favorable long-term result in 80 to 84% cases.Hide