Surgical Left Ventricular Restoration
An Extreme Case
A 72-year-old man presented with end-stage heart failure 12 months after an anterior myocardial infarction. Echocardiography showed a grossly dilated left ventricle (LV) with an apical aneurysm but could not define its borders. The patient was referred for cardiovascular magnetic resonance (MR) imaging. This showed a LV apical true aneurysm measuring 14.4 cm by 14.0cm (Figure 1). “Late enhancement” images after gadolinium contrast revealed the basal 2/3 of the LV to be viable but not the apical aneurysm. The amount of viable (ie, non-hyperenhancing) LV myocardial tissue was quantified as 159 g by planimetry of the late gadolinium images. Subsequently, the patient underwent an endoventricular patch plasty repair (Dor procedure). His postoperative recovery was uncomplicated. The follow-up scan revealed a much smaller LV with an apical Dacron patch (Figure 2). Planimetry of short axis slices allowed precise calculation of pre- and post-surgical left ventricular volumes and ejection fraction. Figure 3 demonstrates the dramatic improvement of these parameters after surgery. Cardiac MR imaging helped surgical planning by defining the extent and nature of the aneurysm and delineating viable and non-viable myocardial territories.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.