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Susan I. Nicholas
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J Thorac Cardiovasc Surg 2005;130:1032-1038
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Left ventricular volume and function after endoventricular patch plasty for dyskinetic anteroapical left ventricular aneurysm in sheep

Peng Zhang, MD, PhD a , b , Julius M. Guccione, PhD a , b , Susan I. Nicholas, MD a , Joseph C. Walker, PhD c , Philip C. Crawford, CCP a , Amin Shamal, MD b , d , David A. Saloner, PhD b , e , Arthur W. Wallace, MD, PhD b , d , Mark B. Ratcliffe, MD a , b , *

a Department of Surgery, University of California, San Francisco, Calif
c Department of Bioengineering, University of California, San Francisco, Calif
d Department of Anesthesia, University of California, San Francisco, Calif
e Department of Radiology, University of California, San Francisco, Calif
b Department of Veterans Affairs Medical Center, San Francisco, Calif.

Received for publication February 1, 2005; revisions received May 9, 2005; accepted for publication May 20, 2005.

* Address for reprints: Mark B. Ratcliffe, MD, Division of Surgical Services (112D), San Francisco Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121. (Email: Mark.Ratcliffe{at}med.va.gov).

OBJECTIVE: Endoventricular patch plasty (the Dor procedure) has gained favor as a surgical treatment for heart failure associated with large anteroapical myocardial infarction. We tested the hypothesis that the Dor procedure reduces left ventricular volume, increases end-systolic elastance, decreases diastolic compliance, and maintains left ventricular function.

METHODS: In 6 male Dorsett sheep, the left anterior descending coronary artery and its second diagonal branch were ligated 40% of the distance from apex to base. Sixteen weeks after myocardial infarction, a Dor procedure was performed with a Dacron patch that was 50% of the infarct neck dimension. Absolute left ventricular volume was measured with magnetic resonance imaging, and left ventricular pressure and relative left ventricular volume changes during pharmacologic preload reduction were measured with a volume conductance catheter 2 weeks before and 2 and 6 weeks after the Dor procedure. End-systolic elastance, diastolic compliance, and Starling relationships were calculated from the resultant left ventricular pressure/volume loops.

RESULTS: Two weeks after the Dor procedure, the left ventricular volume at end systole and end diastole was significantly reduced, and there was no redilation at 6 weeks. Six weeks after the Dor procedure, the ejection fraction was significantly increased. Although stroke volume increased slightly at 6 weeks, the change was not significant. The slopes of end-systolic elastance, diastolic compliance, and Starling relationships were unchanged at 2 and 6 weeks.

CONCLUSIONS: The Dor procedure significantly reduces left ventricular volume. Unlike linear repair, left ventricular volume changes seem stable. The ejection fraction is improved, and left ventricular function (stroke volume and the Starling relationship) is maintained.

17; 22; 30




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