THE INFLUENCE OF CARDIAC GEOMETRY ON THE RESULTS OF VENTRICULAR ANEURYSM REPAIR

  • 1 January 1980
    • journal article
    • research article
    • Vol. 99  (1) , 221-+
Abstract
Operative repair of ventricular aneurysms should improve left ventricular function. Despite its theoretic advantage, the mortality following this operation is high and many patients have severe postoperative hypotension. The cardiac findings were studied in 18 patients who died after repair of ventricular aneurysms. All hearts were examined at autopsy after postmortem coronary arteriography and fixation in a distended state. Five patients in group I had intractable fatal postoperative hypotension, 7 in group II initially had severe hypotension that improved and 6 in group III did not have postoperative hypotension. Curvature thickness indexes (CTI) of the ventricular segments, which correlate with their pressure-producing activity, were determined on the 18 hearts. CTI for the left ventricular free wall and septum were lower in group I and group II patients with hypotension than those in group III without. The reduced CTI in patients with postoperative shock appear to arise as a result of ventricular reconstruction that reduces ventricular wall curvature. Left ventricular function after aneurysm resection would be improved by inverting, rather than everting, the edges of the ventriculotomy, thereby increasing wall curvature and the CTI. Noninvasive determinations of the CTI may be of value in guiding topographic reconstruction of ventricles with aneurysms.