Dr. Kewal Krishan, a senior cardiac surgeon at Temple Health, reviews successful repair of calcific left ventricular aneurysm with with porcelain ventricle, using dacron patch reinforced by pericardium and teflon rim. He explains how ressection of aneurysm in patients with anteroseptal kyskinesia or akinesia provides good clinical and morphological results.
I AM DR cable christian. I'm associate professor and associate director for heart transplant and ventricular assist device program at Temple Hospital philadelphia today I'm gonna present successful surgical repair of giant calcification. Left ventricular aneurysm with porcelain left ventricle. So in the interaction my the most cardiac aneurysms develop after completed myocardial infarction. When the myocardial infarction is massive. The ventricular aneurysms are often clinically silent and diagnosed on routine imaging. Otherwise, the patient can present with symptoms of heart failure, shambolic event or ventricular arrhythmia in the presence of ventricular aneurysm calcification in the an original wall with person ventricle wall is seen very rarely. It usually happens when the patient had a history of my massive AM I in the past like five years, 10 years ago and now there isn't that a kinetic part has become now organized. Left ventricular aneurysm in the left ventricular remodeling. When it happens if you see in the one week it's a little dilatation of the left ventricle and by the three months the remodeling gets settled and it takes the shape of ventricular aneurysm and the ventricle remodeling post Emma is either dis kinetic or a kinetic Some segment works against the contraction and it can be a kinetic means it's not moving at all the innovative way to repair this calcify left ventricular aneurysm. We when the two walls of the ventricle could not be approximately due to calcification to close the cavity. The purpose of surgical repair was to alleviate the deleterious effect of previous M. I. By excluding the non functional scarred area to achieve the original geometry of the ventricle Here, I am describing the two similar cases of the person left ventricle. One is a 60 year old gentleman with just being a Disney on exertion for last 30 days. And he had accused me 10 days ago. Past medical history was significant. M. I 10 years ago we did a coronary angiography and it revealed double vessel coronary disease. On echocardiogram, it showed LV aneurysm with severe aortic stenosis and severe LV dysfunction. And there was large thomas was also present on the septum. He entered antibiotic well replacement with the tissue well and left ventricular aneurysm was repaired with the composite craft. And I can show you this. The ventricular aneurysm is very big and it's a white color, pale and white color aneurysm. You can see under my hand and when we cut the ventricular aneurysm there was a lot of calcification material inside that. And finally after cleaning everything it looks like a courtship and that you can see the speech tools coming out of the ventricular wall there calcifications. And when I tried to approximate the two margins, I could not because it's a calcified, very strong case. Then we had to close this wall. So then what we did was we used a new technique to do that. We used the double value dacron patch with a pericard buoyant pericardial patch made it a composite patch and then put it to cover this gap. And then I put uh felt dacron felt in the margins because it's a it's a large known functional area because the dacron path does not contract. And we don't we didn't want this area to be more inside the ventricle cavity. Otherwise there will be a traumas formation. So we try to reduce that further also to reduce the size of a kinetic part in the ventricle. So this is how the final picture looks like and patient went home uh Within time time limits so that another patient is a 57 year old male with a history of Disney, a positive with coronary artery disease all in fart and calcification. Tourism surgical repair to reshape the ventricle was done along with coronary bypass surgery. And this the giant calcification of the aneurysm was respected with a gap was closed with the acronym as I showed in the previous. But this time it is in the ventricular apex than the anterior wall and all ventricular wall was this kinetic kinetic area which was cut. We cut the you know when put over dacron patch and thomas was removed and coronary bypass salary was done. This is how it looks like you can see when we open the pericardium, the contained rupture, the blood was starting coming out of this, this an original part and it was about to rupture uh this aneurysm. So when we removed all the traumas and this area, the impending rupture area, you can see there was a lot of calcification in that. and this calcification. We could not bring closure to each other. And we made a patch same uh composite patch of bovine pericardium. And uh uh and that that graft. And you can see I had to the rest of the apex. I had to cut with with the hammer small hammer to remove the calcification so that we can put the patch. And and after that putting the patch we didn't want something to leak because ventricle will generate the pressure of 1 21 60. So we put two. For the safety reasons we put a dacron patch in the margins and you can see the final outcome of this how it looks like from inside and from outside. So. And the patient was excavated on day one. In traffic balloon pump was removed on day two. And patient I know troops were wind off on day three and the postoperative course was uneventful. The post tobacco was satisfactory, satisfactory. I meant because when you cut the ventricle and you reshape the ventricle most of the time when the cavity is small, diastolic dysfunction develops, the ventricle does not get enough volume despite the E. F. Looks good. So we have to be really, we have to make sure while making the cavity that the patient should not develop the diastolic dysfunction and the better vehicle geometry is required for the postal. Pretty good function and the postal pretty echo was satisfactory. Everything was fine technique. This technique is a desirable surgical procedure for ventricular restoration and we preserve the adequate diastolic volume and provide a better human dynamic stability. Patient was discharged when they hit calcification. LV. Aneurysms with person ventricle can successfully be repaired with macron reinforced by pericardium and teflon. In patients with Antero septal dyskinesia dyskinesia intersection of aneurysm provides code clinical and morphological results with improvement in ventricular geometry and function. It preserves an adequate diastolic volume that is most important for providing the better him a dynamic stability. After that. Thank you very much for listening to them. I'm doctor cable christian from Temple Hospital. I'm one of the senior cardiac surgeons. Thank you.