Abstract 10590: Characterization of Left Ventricular Regional Morphology and Function Using Cardiac Magnetic Resonance for Planning Optimal Surgical Ventricular Restoration
Background: Patient selection for surgical ventricular restoration (SVR) by accurate assessment of LV morphology & function and virtual comparison of different surgical techniques by pre-surgical planning helps determine optimal outcomes.
Hypothesis: Novel CMR-based methods can be used to verify improvements in LV morphology and function following SVR.
Methods: LV remodeling in 7 patients (NYHA Class IV) with post myocardial infarction LV aneurysms was characterized by regional LV volume (RLVV) computed by dividing the LV in cine SSFP CMR at each slice-level into 6 radial segments. All patients were subjected to SVR virtually, with circular and linear patch-plasty (EVCPP &EVLPP), respectively. The two resulting procedures were compared using a phase-to-phase regional distance metric of peak endocardial wall motion - Hausdorff distance (HD). Based on these analytics, all patients underwent SVR by EVLPP. Pre- & postoperative apical conicity ratio (ACR) was computed in 3D to establish restored LV apical geometry.
Results: Mean EDV was 161.8±99.3 ML & mean EF was 18.2±8.8%. Following SVR, all patients had significant clinical improvements (NYHA class I), and significant increases in LV EF to 38.8±4.4%. LV volumes and apical RLVV decreased after SVR. The ACR decreased significantly from 1.90±0.43 to 1.35±0.3 (P=0.02) with increases in apical EF 1.19±13.9% to 15.8±8.2% (p=0.028), indicating improved apical conicity. The reversed pre-operative basal LV rotation and reduced apical rotation improved significantly(Figure:1). The mean HD was significantly greater after EVLPP (0.474±0.190 mm increased to 0.722±0.221 mm, p=0.047) than EVCPP (0,474±0.190 mm increased to 0.594±0.193, p=0.175) suggesting that EVLPP provided better scar exclusion.
Conclusions: In patients with LV aneurysms, a significant correlation exists between regional LV remodeling and aneurysm location. The HD method can be used for devising optimal patient-specific SVR techniques.
- © 2013 by American Heart Association, Inc.