scholarly journals 453 An unexpected finding in an asymptomatic patient planned for non-cardiac surgery

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Laura Fusini ◽  
Anna Degiovanni ◽  
Paolo Devecchi ◽  
Alessia Veia ◽  
Roberta Rosso ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Multimodality Imaging ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Thin Wall ◽  
Mitral Valve Leaflet ◽  
Graft Thrombosis ◽  
Risk Of Rupture ◽  
Wide Neck

Abstract Aims Left ventricular (LV) aneurysms and pseudoaneurysms are two complications of myocardial infarction, either symptomatic or silent, leading to death or serious morbidity in several cases and often precluding non-cardiac surgery. Here the differential diagnosis is challenging and multimodality imaging is often needed to assess the risk of heart rupture. Methods and results A 71 years-old woman was referred to our Cardiology Department for a preoperative evaluation before lung lobectomy. Her past medical history included multiple cardiovascular risk factors and abdominal aorta aneurysm. She also had severe peripheral arterial disease treated with femoral popliteal bypass surgery in June 2021. In August 2021 she suffered from vascular graft thrombosis requiring a redo surgery. During hospitalization, she was found to have a lung adenocarcinoma. The patient had an unremarkable cardiological history and was asymptomatic. EKG was unremarkable. Transthoracic echocardiography revealed a mildly impaired LV systolic function (EF = 40%), an inferolateral basal wall akinesia and a huge aneurysm with intracavitary thrombus and a wide neck arising right below the posterior mitral annulus. The annular distortion caused by the expanding aneurysm contributed to the development of mitral regurgitation (MR) by displacing the annulus and subvalvular apparatus, resulting in restriction of the posterior mitral valve leaflet, coaptation failure, and moderate MR. Coronary angiography demonstrated a severe 3-vessel coronary artery disease. To further characterize the aneurysm, a cardiac magnetic resonance was carried out. T1 weighted inversion recovery LGE 2-chamber and short axis views showed transmural LGE of the inferior wall and confirmed the presence of a saccular dilatation with thin wall, wide neck (5 × 6 cm) and large intracavitary thrombus at high risk of rupture. Since the presence of metastatic lesions was excluded, the patient underwent cardiac surgery followed by elective lobectomy. Intraoperative findings were consistent with LV aneurysm with a thin myocardial wall. Aneurysm and related thrombus were removed and the orifice was closed with a Dacron patch. In the same setting a myocardial revascularization with two coronary artery bypass grafts was also performed. Surgery was successfully performed without any complication. Intraoperative transesophageal echocardiography clearly revealed the aneurysm and witnessed the reduction of MR after the restoration of LV inferolateral wall geometry. Conclusions Our case highlights the importance of thorough evaluation prior to non-cardiac surgery using multimodality imaging, especially when incidental echocardiographic findings in asymptomatic patients occur. A careful pre-operative assessment of patients planned for non-cardiac surgery is the key to favourable postoperative outcome.

scholarly journals P260 Left ventricular pseudoaneurysm manifesting as syncope

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J A Da Conceicao Pedro Pais ◽  
B Picarra ◽  
K Congo ◽  
M Carrington ◽  
A R Santos ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Pericardial Effusion ◽  
Coronary Disease ◽  
Transthoracic Echocardiography ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Cardiac Revascularization ◽  
Revascularization Surgery

Abstract Introduction Left ventricular (LV) pseudoaneurysms form when cardiac rupture is contained by adherent pericardium or scar tissue. LV pseudoaneurysm is one of the mechanical complications of myocardial infarctions (MI), particularly inferior wall MI. Although LV pseudoaneurysms are not common, the diagnosis is difficult and they are prone to rupture. Transthoracic echocardiography is commonly used in clinical practice and is usually sufficient to make the diagnosis of LV pseudoaneurysm. Regardless of treatment, patients with LV pseudoaneurysms had a high mortality rate, especially those who did not undergo surgery. Description of the clinical case 74 years-old woman, with previous history of hypertension, dyslipidaemia and type 2 diabetes and stable coronary disease. In June 2018 the patient underwent coronary angiography that revealed left main and 3 vessels coronary disease, Cardiac revascularization surgery was proposed that the patient refused. The patient was stable during 6 months. Four days before presenting to emergency department the patient mentioned intermittent pre-cordial pain associated with exertion. At admission day she felt intense pre-cordial pain, accompanied by sudoresis and nausea, relieving with sublingual nitrate. The patient was hemodynamically stable at admission. Electrocardiogram showed sinus rhythm 65 bpm with 2mm ST-elevation of inferior leads. Troponin I was positive 30 ng/dL. Echocardiogram revealed marked hypokinesia of inferior and lateral wall with moderate depression of global systolic function ans presence of slight circumferential pericardial effusion (6mm in diastole on lateral wall) Emergent coronariography was performed and revealed progression of coronary disease of the right coronary artery with sub-occlusion of the mid segment. Cardiac revascularization surgery was proposed and the patient accepted this time. Echocardiogram was repeated during hospitalization revealed a stable pericardial effusion with reduced dimension comparing to admission. After 3 weeks, while waiting surgery in the ward, the patient was a syncope that resulted in fracture of the distal peroneum. Ecocardiogram was performed and revealed a LV posterior wall pseudoaneurysm through a narrow neck in parasternal long axis view and the presence of large pericardial effusion (Fig 1). The patient was submitted to definitive reparative cardiac surgery with pericardium patch and coronary artery bypass graft from left internal mammary to anterior descending coronary artery. The patient recovered well from the cardiac surgery and at 2 months follow up is alive and without signs of heart failure. This case illustrates the complexity in the management of patients with LV pseudoaneurysm. These patients require substantial critical care, imaging and surgical expertise. A high clinical index of suspicion is needed to avoid missing the diagnosis LV pseudoaneurysm and transthoracic echocardiography is essential to establish the diagnosis. Abstract P260 Figure. Fig 1 - LV pseudoaneurysm

External Reshaping of the Left Ventricle in Off-Pump Surgery

2006 ◽  
Vol 1 (4) ◽  
pp. 155-159
Author(s):  
Sotirios N. Prapas ◽  
Demetrios A. Protogeros ◽  
Vassilios N. Kotsis ◽  
Ioannis A. Panagiotopoulos ◽  
Ioannis P. Raptis ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Ejection Fraction ◽  
Heart Surgery ◽  
Bypass Graft ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Off Pump ◽  
Anterolateral Wall

Background Dyskinetic areas of the lateral and inferior left ventricular (LV) wall are frequently encountered in patients with coronary artery disease. In clinical practice, all of the techniques described for the restoration of shape and function of the LV require cardiopulmonary bypass. A new technique of LV external reshaping that aims to obtain a near-normal ventricular conical shape is described. This technique is performed during an off-pump coronary artery bypass graft (CABG) operation. It is used mainly on the inferior and lateral walls of the ventricle, but also on the anterolateral wall when warranted. This technique can be considered an alternative to classic aneurysmectomy in high-risk cases. Methods All patients underwent total arterial revascularization without aortic manipulation. Intraoperative transesophageal echocardiography was used in all cases to define the dilated akinetic/dyskinetic area. This area was effectively plicated using interrupted mattress sutures reinforced with Teflon felt or pericardial strips. This technique allows near normalization of the geometry of the ventricle and LV end-diastolic volume reduction. In cases of preexisting mitral regurgitation (MR), a reduction of the MR was observed after lateral wall restoration. From September 2002 to April 2005, the external reshaping technique was applied on 56 cases among 949 off-pump CABG cases (5.9%). A detailed transthoracic echocardiogram was obtained preoperatively. The mean ejection fraction of all enrolled patients was 31.2 ± 7%. The location of the plication was: lateral wall in 22, inferior wall in 16, and anterolateral wall in 18. The average number of coronary anastomoses was 2.6. Twelve patients were found to have 2–3 + MR. All patients were followed up during a period of 35 months. Results One patient died due to severe right ventricular dysfunction. Seven patients developed atrial fibrillation, and one had ventricular tachycardia. During the follow-up period, we observed a reduction of left ventricular end-diastolic diameter and a parallel augmentation of ejection fraction (mean 42.2 ± 4%). The ventricular cavity's architecture was normalized. Among the 12 patients with MR, an improvement of regurgitation was noted in 10 (from 2–3+ to 1–2+). One patient died during the follow-up period, and 1 patient required reoperation due to persistent severe MR. Conclusions The external reshaping of the LV during beating heart surgery is technically feasible, has promising results, and can be performed without major complications.

scholarly journals 497 Multimodality imaging of an evergreen conundrum: true or false aneurysm of the left ventricle?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Garau ◽  
D Cocco ◽  
L Corda ◽  
V Palmisano ◽  
M Porcu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
False Aneurysm ◽  
Diagnostic Yield ◽  
Systolic Function ◽  
Multimodality Imaging ◽  
Myocardial Revascularization ◽  
Mechanical Complication ◽  
Heart Team ◽  
Inferior Wall ◽  
Lv Aneurysm

Abstract In case of transmural necrosis following STEMI, the myocardial wall may develop a true or false aneurysm. While the former usually has a benign course, the latter has a propensity to rupture leading to an ominous prognosis. We report the case of a patient with a recent inferior STEMI complicated with LV aneurysm of the inferior wall, initially diagnosed as a false aneurysm. We describe the case of a 77-year-old man affected by hypertension, diabetes and AF. Two months before he experienced an inferior STEMI treated with late (>12 hours from symptoms onset) pPCI and implantation of a DES on the RCA and the postero-lateral branch. TTE showed a mildly reduced LV systolic function (EF 50%) due to akinesia of the inferior wall. The patient presented to the ED for recurrent syncopes at rest. Vital signs were unremarkable. Troponin and electrolytes were within normal range. ECG showed a normofrequent sinus rhythm and Q waves with persistent ST elevation in the inferior leads. TTE showed a suspected rupture of the inferior wall in the middle segment between the posterolateral papillary muscle and the mitral annulus. The rupture seemed to be contained by the pericardium so as to create a huge cavity communicating with the LV through an apparently small neck and refurnished with turbolent blood during the cardiac cycle. In the suspicion of a pseudoaneurysm ( an urgent cardiac CT was performed. CT showed an extraventricular cavity apparently contained by the pericardium with a narrow neck and a pericardial effusion of a high density liquid. A diagnosis of post-infarction pseudoaneurysm was made. The day after the patient was stable but TTE showed a mild increase of the size of the "pseudoaneurysm", hence the Heart Team referred the patient to the cardiac surgery department for an urgent repair. In the surgical room TOE displayed the large cavity rising from the inferior wall of the LV and the communication thorugh a large neck. The intraoperatory finding was, unexpectedly, a true aneurysm of the inferior wall. The redundant aneurysm was excised and the defect was succesfully closed with a bovine pericardium patch. No periprocedural complication was recorded and the postoperatory period was uneventful. The present case strikingly shows how a mechanical complication may develop in spite of myocardial revascularization. The high level of suspicion led to a strong effort to achieve a definite diagnosis. Multimodality imaging plays a pivotal role and is warranted since the initial evaluation with TTE may be inconclusive. CT has a high diagnostic yield but false positives may happen. MRI could have been more specific in our case, but the clinical evolution and the CT images led us to be confident in referring the patient to an urgent cardiac surgery. In conclusion, the non invasive differential diagnosis between true and false aneurysm still remains a modern challenge. Abstract 497 Figure. Multimodality imaging of a LV aneurysm

Abstract 15789: Cardiac MRI With Adenosine Identifies Coronary Stenosis, Perfusion Defects, and Delayed Enhancement in Pediatric Patients With Anomalous Aortic Origin of a Coronary Artery Before and After Surgical Repair

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Julie A Brothers ◽  
Timothy S Kim ◽  
Mark A Fogel ◽  
Kevin K Whitehead ◽  
Stephen A Paridon ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Cardiac Mri ◽  
Surgical Repair ◽  
Statistical Significance ◽  
Left Ventricular ◽  
Lv Function ◽  
Inferior Wall ◽  
Before And After ◽  
Perfusion Defects ◽  
Anomalous Coronary

Background: Anomalous aortic origin of a coronary artery (AAOCA) with an interarterial course is associated with sudden cardiac death in children. Objectives: Using cardiac MRI with adenosine, we evaluated coronary ostial stenosis, proximal coronary size, and left ventricular (LV) function in children with AAOCA. Methods: We prospectively enrolled children 5-18 years old with interarterial AAOCA. MRIs were reviewed for coronary artery origin, proximal course, dimensions, and cardiac function. Surgery consisted of the modified unroofing procedure. We used descriptive statistics and paired t-tests to evaluate for statistical significance. Results: Between 2/2009 and 5/2014, 24 subjects with AAOCA underwent 29 MRIs. The majority were male (N=19, 79%) with anomalous right coronary artery (AAORCA, N=20, 83%). Mean age was 12.8 years at time of initial MRI. MRI was performed an average of 7 months post-operatively in 8 subjects who underwent surgery. In all, the proximal anomalous coronary arose tangential to the aorta with an elliptical, slit-like ostium. The anomalous coronary measured smaller proximally (0.20 mm) compared to distally (0.31 mm, P=< 0.0001), and after surgical repair, the post-operative origin was significantly larger (0.36 vs. 0.21 mm, P=0.02). Other abnormalities at initial MRI included fixed inferior wall (N=1) and reversible subendocardial septal/inferior wall (N=1) perfusion defects. Post-operatively, the neo-ostium was round in 6 (see Figure), but in 2, the orifice remained elliptical. One patient had a new small mid-myocardial scar and one had dyskinetic septal wall motion. LV function was normal both before and after surgery (mean ejection fraction =68.1% vs. 67.5%, P=0.85). Conclusions: Cardiac MRI with adenosine is an important tool for the evaluation of anomalous anatomy, myocardial function, and ischemia/injury and should be considered for the initial and, when applicable, post-operative assessment of children with AAOCA.

scholarly journals Successful Revascularization to Right Coronary Artery by Percutaneous Coronary Intervention after Endovascular Therapy for Leriche Syndrome

2014 ◽  
Vol 7 ◽  
pp. CCRep.S13551 ◽  
Author(s):  
Takeshi Niizeki ◽  
Kazuyoshi Kaneko ◽  
Shigeo Sugawara ◽  
Toshiki Sasaki ◽  
Yuichi Tsunoda ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Endovascular Therapy ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Leriche Syndrome ◽  
Percutaneous Coronary ◽  
The Right

A 69-year-old man with effort angina was admitted to our institution. Echocardiography showed poor left ventricular systolic function with akinesis of the anterior wall and severe hypokinesis of the inferior wall. We performed coronary angiography, which revealed two diseased vessels including chronic total occlusion in the left anterior descending artery and severe stenosis in the right coronary artery (RCA). In addition, aortography revealed aortoiliac occlusive disease known as Leriche syndrome. As the patient's symptom was stable, we first planned to perform endovascular therapy (EVT) for Leriche syndrome to make a route for intra-aortic balloon pumping. We prepared a bi-directional approach from bi-femoral arteries and a left brachial artery. The guidewire was passed through the occlusive area using the retrograde approach. The self-expanding stents were deployed by a kissing technique. At one week after EVT, a 6Fr sheath was inserted from the right radial artery and an intra-aortic balloon pump was successfully inserted through the right femoral artery for percutaneous coronary intervention (PCI) to the RCA. Two drug-eluting stents were successfully deployed to RCA after using an atherectomy device (rotablator). We reported the case as a successfully performed PCI to the RCA after EVT for Leriche syndrome.

Assessment of a left circumflex coronary artery–left ventricle fistula by multimodality imaging in a child

2016 ◽  
Vol 27 (3) ◽  
pp. 570-572
Author(s):  
Jing Chen ◽  
Zhi-Gang Yang
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Multimodality Imaging ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Early Surgery ◽  
Circumflex Coronary Artery ◽  
Left Circumflex Coronary Artery ◽  
Tissue Tracking

AbstractMultimodality imaging revealed a left circumflex coronary artery–left ventricle fistula in a 4-year-old boy. MRI tissue tracking revealed a slight abnormality in the left ventricular myocardial strain. Early surgery was suggested to avoid serious complications.

scholarly journals P704 Mechanical complications of acute myocardial infarction in the era of early reperfusion therapy: a case report

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Proenca ◽  
R Alves Pinto ◽  
M Martins Carvalho ◽  
A Nunes ◽  
P M Araujo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular ◽  
Mechanical Complication ◽  
Heart Team ◽  
Inferior Wall ◽  
Early Reperfusion ◽  
Mechanical Complications ◽  
Biventricular Function ◽  
Risk Of Rupture

Abstract Introduction Left ventricular pseudoaneurysm is a rare mechanical complication of myocardial infarction, and its incidence has decreased with the widespread use of reperfusion therapies. Pseudoaneurysm is the result of a free wall rupture contained by pericardial adherences and mural thrombi, which contain the bleeding and prevent cardiac tamponade. Clinical Presentation A 68-year-old woman who had hypertension, diabetes mellitus and chronic kidney disease (caused by diabetic nephropathy) was first admitted with acute myocardial infarction of the inferior wall. Emergent coronary angiography revealed proximal occlusion of the right coronary artery. Primary angioplasty was performed with three stents implantation. However due to transitory no reflow, verapamil, nitrate and intracoronary abciximab were administered with recovery of coronary flow. Patient remained stable, without recurrence of symptoms. Echocardiography, at discharge, showed normal biventricular function and no mechanical complications. Two months later, the patient was readmitted in the emergency room with constant chest pain, fatigue, prostration and loss of appetite beginning ten days earlier and an episode of syncope. Physical examination revealed fever, cardiac auscultation was rhythmic and without murmurs or pericardial friction rub, and pulmonary auscultation revealed crackles in inferior hemithorax. 12-lead electrocardiogram showed sinus rhythm, Q waves and negative T waves in inferior leads. Blood tests revealed leucocytosis, high sensibility troponin I was 28,8 ng/L and brain natriuretic peptide was 264,9 pg/mL. Chest-X-ray demonstrated enlargement of the cardiac silhouette and echocardiography showed moderate to large pericardial effusion with large amounts of fibrin close to right cardiac chambers and a basal inferior pseudoaneurysm with 23 mm x 24 mm; intracavitary contrast was administered without opacification of pericardial space; biventricular function remained normal. Patient was promptly admitted on Cardiac Intensive Care Unit with diagnosis of pseudoaneurysm due to myocardial infarction. Therapeutic with ticagrelor was suspended and surgical correction was proposed, after discussion in Heart Team. False aneurysm correction was performed with a bovine pericardial patch without complications, and the patient was discharged asymptomatic eight days later. Conclusion Even with lower incidence, pseudoaneurysms remains as a potential life-threatening due to its high risk of rupture. Prompt diagnosis, usually with echocardiography and surgical referral are crucial. Abstract P704 Figure. Inferior Pseudoaneurysm

scholarly journals Severe multivessel coronary artery spasm detected by computed tomography: a case report

2020 ◽  
Author(s):  
Cai De Jin ◽  
Moo Hyun Kim ◽  
Su-A Jo ◽  
Kyunghee Lim
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Troponin I ◽  
Coronary Artery Spasm ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Inferior Wall ◽  
Total Occlusion ◽  
Ventricular Ejection Fraction

Abstract Background Ventricular arrhythmia and sudden cardiac arrest caused by multivessel coronary artery spasm (CAS) is rare. Although coronary angiography (CAG) with provocation testing is the diagnostic gold standard in current vasospastic angina guidelines, it can cause severe procedure-related complications. Here, we report a novel technique involving dual-acquisition coronary computed tomography angiography (CCTA) to detect multivessel CAS in a patient who survived out-of-hospital cardiac arrest (OHCA). Case summary A 58-year-old healthy Korean male survived OHCA caused by ventricular fibrillation (VF), experiencing seven episodes of defibrillation and cardiopulmonary resuscitation, and was referred to the Emergency Room. Vital signs were stable and physical examination, electrocardiogram, chest, and brain CT did not show any abnormal findings, except elevated hs-Troponin I levels (0.1146 ng/mL). Echocardiogram revealed a regional wall motion abnormality in the inferior wall, with a low normal left ventricular ejection fraction (50%). A multivessel CAS (both left and right) was detected using a dual-acquisition CCTA technique (presence and absence of intravenous nitrate). During CAG with the 2nd injection of ergonovine, a prolonged and refractory total occlusion in the proximal-ostial right coronary artery was completely relieved after a seven-cycle intracoronary injection regimen of nitroglycerine. The patient was discharged with the recommendation of smoking and alcohol cessation. Nitrate and calcium channel blockers were also prescribed. The patient had no further events at 3 months of follow-up after discharge. Discussion Dual-acquisition CCTA is a promising tool to detect multivessel CAS.

scholarly journals Kairiojo skilvelio geometrijos ir tūrio atkūrimo operacija: priešoperaciniai ir operaciniai rizikos veiksniai

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Gintaras Kalinauskas ◽  
Robertas Samalavičius ◽  
Arūnas Valaika ◽  
Gediminas Norkūnas ◽  
Jurgis Verižnikovas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Emergency Surgery ◽  
Left Ventricular ◽  
University Hospital ◽  
Dor Procedure ◽  
Vilnius University

Gintaras Kalinauskas1, Robertas Samalavičius2, Arūnas Valaika1, Gediminas Norkūnas1, Jurgis Verižnikovas3, Giedrius Uždavinys11 Vilniaus universiteto Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto ligoninės Santariškių klinikos, Anesteziologijos,intensyviosios terapijos ir skausmo gydymo centras, Santariškių g. 2, LT-08661 Vilnius3 Vilniaus universiteto ligoninės Santariškių klinikos Širdies chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas / tikslas Ligoniams, kuriems yra poinfarktinė kairiojo skilvelio remodeliacija, reikalinga kairiojo skilvelio geometrijos ir tūrio atkūrimo operacija (Dor procedūra). Parenkant ligonius operacijai svarbu išsiaiškinti, kurie iš priešoperacinių ir operacinių rizikos veiksnių labiausiai turi įtakos operaciniam mirštamumui. Ligoniai ir metodai Tai retrospektyvus tyrimas. Ligoniai buvo operuoti laikotarpiu nuo 2000 metų sausio 1 dienos iki 2006 metų gruodžio 31 dienos. Išnagrinėti 88 ligonių, 69 vyrų ir 19 moterų, kurių amžiaus vidurkis 64,5±9,8 metų ir jiems atliktos aortos vainikinių arterijų jungčių suformavimo ir kairiojo skilvelio geometrijos ir tūrio atkūrimo operacijos (Dor procedūra), priešoperaciniai ir operaciniai duomenys. Rezultatai Iš 88 operuotų ligonių šeši ligoniai mirė, mirštamumas 6,8%. Mirusių ligonių priešoperacinės būklės EuroSCORE įvertinimo balas reikšmingai skyrėsi nuo išgyvenusiųjų (p = 0,0180), tai buvo sunkesni, didesnės rizikos ligoniai. Išaiškėjo, kad mirę ligoniai buvo dažniau operuoti skubos tvarka (p = 0,0077). Jų operacijos truko ilgiau, ilgesnė buvo ir jų dirbtinė kraujo apytaka. Išvados EuroSCORE balais vertinamas priešoperacinės būklės sunkumas, skubi operacija, ilgas operacijos ir dirbtinės kraujo apytakos laikas yra gana reikšmingi veiksniai vertinant operacijos riziką. Pagrindiniai žodžiai: kairiojo skilvelio geometrijos ir tūrio atkūrimo operacija Left ventricular reconstruction: preoperative and operative risk factors Gintaras Kalinauskas1, Robertas Samalavičius2, Arūnas Valaika1, Gediminas Norkūnas1, Jurgis Verižnikovas3, Giedrius Uždavinys11 Vilnius University, Cardiac Surgery Centre, Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Vilnius University Hospital „Santariškių klinikos“, Centre of Anaesthesiology,Intensive Therapy and Pain Management, Santariškių str. 2, LT-08661 Vilnius, Lithuania3 Vilnius University Hospital „Santariškių klinikos“,Cardiac Surgery Centre,Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Background / objective The dor procedure is a surgical option in patients with coronary artery disease and postinfarction left ventricular aneurysm. The aim of this study was to evaluate our clinical experience in this procedure and determine risk factors for in-hospital mortality. Patients and methods This was a retrospective investigation. From January 1, 2000 to December 31, 2006, surgical ventricular restoration was performed in 88 patients (69 males), mean age 64.5 ± 9.8 (42–80) years. Patient with valve repair or replacement were excluded from the study. Results All patients underwent the Dor procedure with coronary artery bypass grafting. Crude mortality rate was 6.8%. Higher EuroSCORE, longer operation and cardiopulmonary bypass time and emergency surgery were univariate predictors of in-hospital mortality. Conclusions The Dor procedure with myocardial revascularization can be performed with acceptable mortality in this high risk group of patients. Higher EuroSCORE, longer operation and cardiopulmonary bypass time and emergency surgery increase the risk of in-hospital mortality. Key words: Dor procedure

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