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Ann Thorac Surg 2003;75:1205-1208
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

Ventricular energetics in endoventricular circular patch plasty for dyskinetic anterior left ventricular aneurysm

Yoshihisa Tanoue, MDa*, Hiromi Ando, MDa, Fumio Fukumura, MDa, Masayoshi Umesue, MDa, Takayuki Uchida, MDa, Kenichiro Taniguchi, MDa, Jiro Tanaka, MDa

a Cardiovascular Surgery, Aso-Iizuka Hospital, Iizuka, Japan

Accepted for publication November 6, 2002.

* Address reprint requests to Dr Tanoue, Department of Cardiovascular Surgery, Aso-Iizuka Hospital, Yoshio-cho 3-83, Iizuka-city 820-8505, Japan.
e-mail: tanoue{at}heart.med.kyushu-u.ac.jp

BACKGROUND: The endoventricular circular patch plasty (Dor procedure) applies to patients with a left ventricular dysfunction due to an ischemic dilated ventricle. In the present study, we analyzed left ventricular energetics in patients who underwent the Dor procedure.

METHODS: We measured left ventricular contractility (end-systolic elastance; Ees), afterload (effective arterial elastance; Ea), and efficiency (ventriculoarterial coupling; Ea/Ees, and the ratio of stroke work and pressure-volume area; SW/PVA) based on the cardiac catheterization data before and after the Dor procedure in 8 patients with a postinfarction dyskinetic anterior left ventricular aneurysm. Concomitant procedures included coronary artery bypass grafting in all patients, mitral valve repair in one patient, and cryoablation in one patient. End-systolic elastance (Ees) and Ea were approximated as follows: Ees = mean arterial pressure/minimal left ventricular volume, and Ea = maximal left ventricular pressure/(maximal left ventricular volume–minimal left ventricular volume), and thereafter Ea/Ees and SW/PVA were calculated. The left ventricular volume was normalized with the body surface area.

RESULTS: End-systolic elastance (Ees) increased after the Dor procedure (from 1.15 ± 0.60 to 1.86 ± 0.84 mm Hg · m2 · mL-1, p < 0.01), thus resulting in an improvement in Ea/Ees and SW/PVA (from 2.94 ± 1.11 to 1.64 ± 0.49, p < 0.01, and from 0.426 ± 0.110 to 0.559 ± 0.082, p < 0.01, respectively), even though Ea did not substantially change (from 2.96 ± 0.78 to 2.74 ± 0.55 mm Hg · m2 · mL-1, p = 0.4).

CONCLUSIONS: Left ventricular contractility and efficiency improves after the Dor procedure in patients with a dyskinetic anterior left ventricular aneurysm. However, afterload does not change. The use of appropriate afterload-reducing therapy thus plays an especially important role in the management of patients who undergo the Dor procedure.




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