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J Thorac Cardiovasc Surg 2002;123:700-706
© 2002 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Reverse remodeling and improved regional function after repair of left ventricular aneurysm

From the Departments of Medicine and Radiology,^a University of Virginia, Charlottesville, Va, the Departments of Cardiothoracic Surgery^b and Medicine,^c Allegheny General Hospital, Pittsburgh, Pa, and the Department of Cardiovascular-Thoracic Surgery,^d Rush Medical College, Chicago, Ill.

Supported by a grant from the Allegheny General Hospital Auxiliary.

Received for publication May 3, 2001. Accepted for publication Oct 1, 2001. Address for reprints: Christopher M. Kramer, MD, University of Virginia Health System, Departments of Medicine and Radiology, Box 800170, Charlottesville, VA 22908 (E-mail: ckramer{at}virginia.edu).

Background: Changes in regional left ventricular mechanics after anteroapical aneurysm repair in human subjects can be studied noninvasively by means of magnetic resonance tagging. We hypothesized that left ventricular intramyocardial function would improve throughout the left ventricle after repair.
Methods: We studied 6 male patients with a left ventricular anteroapical aneurysm (mean age ± SD, 63 ± 5 years) using magnetic resonance tagging 3 ± 1 weeks before and 6 ± 1 weeks after aneurysm repair, coronary artery bypass grafting, and mitral valve repair (n = 2). Breath-hold tagged imaging spanned the left ventricle in the short axis from apex to base. Left ventricular mass, end-diastolic and end-systolic volume, and ejection fraction were measured. Two-dimensional strain analysis was applied; averaged for the apical, middle, and basal left ventricle and the whole left ventricle; and expressed as greatest lengthening (similar to wall thickening), greatest shortening, and angular deviation of the lengthening strain from the radial direction.
Results: After aneurysm repair, left ventricular mass decreased from 373 ± 27 to 333 ± 25 g (P < .05), end-diastolic volume from 212 ± 22 to 168 ± 18 mL (P < .005), and end-systolic volume from 188 ± 26 to 113 ± 18 mL (P < .005); ejection fraction improved from 13% ± 4% to 23% ± 4% (P < .005). For the whole left ventricle, lengthening strain increased from before to after the operation (8% ± 1% to 10% ± 1%, P < .01). Most of the improved lengthening occurred at the middle left ventricle (8% ± 1% to 11% ± 1%, P < .01), in the base (8% ± 1% to 10% ± 1%, P < .05), and in the inferior wall (9% ± 1% to 12% ± 1%, P < .05). Lengthening tended to become more radially oriented, decreasing from 31° ± 3° to 27° ± 3° (P = .10). Shortening strain did not change (10% ± 1% to 11% ± 1%, P = not significant).
Conclusions: Left ventricular aneurysm repair is associated with reverse remodeling and an improvement in the extent and orientation of intramyocardial function, especially at the middle and basal left ventricle and inferior wall.

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