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J Thorac Cardiovasc Surg 2006;131:579-586
© 2006 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
a Department of Surgery, University of California, San Francisco
c Department of Bioengineering, University of California, San Francisco
e Department of Anesthesia, University of California, San Francisco
f Department of Radiology, University of California, San Francisco
b Department of Veterans Affairs Medical Center, San Francisco, Calif
d Laboratory of Cardiac Energetics, National Institutes of HealthNational Heart Lung and Blood Institute, Bethesda, Md
Received for publication January 20, 2005; revisions received July 11, 2005; accepted for publication July 19, 2005. * Address for reprints: Julius M. Guccione, MD, Division of Surgical Services (112D), Department of Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121 (Email: Julius.Guccione{at}med.va.gov).
OBJECTIVES: Although repair of left ventricular aneurysm has been extensively studied, its effect on regional ventricular function remains unclear. The primary goal of this study was to quantify the effect of anteroapical aneurysm plication on systolic deformation in noninfarcted adjacent (border zone) and remote left ventricular regions in sheep.
METHODS: Eight sheep underwent anteroapical myocardial infarction (25% of left ventricular mass). Ten weeks later, animals underwent aneurysm plication. Two and 6 weeks after this operation, animals underwent magnetic resonance imaging with tissue tagging in multiple short-axis and long-axis slices. Fully 3-dimensional strain analyses were performed. All 6 end-systolic strain components were compared at midwall in the border zone of the aneurysm or repair and in regions 1 cm, 2 cm, and 3 cm below the valves.
RESULTS: Circumferential shortening progressively increases from before plication to 2 weeks after plication to 6 weeks after plication toward the border zone. The effect on circumferential shortening is most pronounced in the anterior wall and septum. The biggest change is from 2 to 6 weeks after plication (from 4.3% to 11.3% in anterior wall, P < .0001; from 3.5% to 6.5% in septum, P < .0007). Longitudinal shortening is decreased at 2 weeks after plication but then returns to baseline (with slight improvement in the border zone) at 6 weeks after plication.
CONCLUSIONS: Repair of left ventricular aneurysm significantly increases systolic circumferential shortening at the border zone in sheep.
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