2015


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2015/№2

Comparative characteristics of the left ventricle preoperative modeling based on data of echocardiography and magnetic resonance tomography

Chernyavsky A. M., Denisova M. A., Kareva Yu. E., Kurbatov V. P.
Federal State Budgetary Institution, "Academician E.N. Meshalkin Novosibirsk Research Institute of Circulatory Pathology" of the RF Ministry of Health Care, Rechkunovskaya 15, Novosibirsk 630055

Keywords: aneurysm, surgical therapy

DOI: 10.18087/rhfj.2015.2.2030

Background. Selection of an optimum surgical intervention for postinfarction heart aneurysm is based, at the stage of planning, on accurate evaluation of LV volumetric and functional parameters. Magnetic resonance tomography (MRT) allows detailed evaluation of LV contractility and overall myocardium viability, which is essential for selection of the LV plasty method. Aim. To evaluate the method of preo­perative LV cavity modeling in patients with postinfarction heart aneurysm based on MRT data. Materials and methods. Surgical reconstruction of LV cavity with myocardial revascularization was performed in 45 patients. Mean age of patients was 56.9±10. Mean number of MIs per patient was 1.5±0.9. Surgical interventions were performed under the conditions of extracorporeal circulation and normothermia for all patients. In-hospital mortality was absent. According to data of preoperative EchoCG, in 4‑chamber view, the LV end-diastolic vo­lume (EDV) was 189.1±518 ml and LV EF was 38.2±6.0 %; in 2‑chamber view, LV EDV was 204.5±54.6 ml and LV EF was 38.6±6.8 %. According to preoperative MRT, LV EDV was 252.2±60.5 ml and LV EF was 27.1±7.1 %. Results. In the modeling based on MRT, LV EDV should be 189.7±424 ml; LV EF – 33.9±7.6 %; and the resection area – 42.7±14.7 cm2. According to data of the follow-up postoperative MRT, LV EDV was 197.5±42.0 ml (р=0.18) and LV EF was 30.9±8.5 % (р=0.001). Conclusion. In postinfarction heart aneurysm, the preoperative modeling of LV cavity based on MRT data is unbiased and allows clear outlining the required area of LV cavity resection to create necessary conditions for recovery of myocardial contractility. This method is safe and does not increase in-hospital mortality.
  1. Gardner BI, Bingham SE, Allen MR et al. Cardiac magnetic resonance versus transthoracic echocardiography for the assessment of cardiac volumes and regional function after myocardial infarction: an intrasubject comparison using simultaneous intrasubject recordings. Cardiovasc Ultrasound. 2009 Aug 18;7:38.
  2. De Haan S, de Boer K, Commandeur J et al. Assessment of left ventricular ejection fraction in patients eligible for ICD therapy: Discrepancy between cardiac magnetic resonance imaging and 2D echocardiography. Neth Heart J. 2014 Oct;22 (10):449–55.
  3. Lloyd SG, Buckberg GD. Use of cardiac magnetic resonance ima­ging in surgical ventricular restoration. Eur J Cardiothorac Surg. 2006 Apr;29 (Suppl 1):216–24.
  4. Warwick R, Pullan M, Poullis M. Mathematical modelling to identify patients who should not undergo left ventricle remodelling surgery. Interact Cardiovasc Thorac Surg. 2010 May;10 (5):661–5.
  5. Menicanti L1, Di Donato M. Left ventricular aneurysm / reshaping techniques. Multimed Man Cardiothorac Surg. 2005 Jan 1;2005 (425).
  6. Hartyánszky I, Tóth A, Berta B et al. Personalized surgical repair of left ventricular aneurysm with computer-assisted ventricular engineering. Interact Cardiovasc Thorac Surg. 2014 Nov;19 (5):801–6.
  7. Чернявский А. М., Караськов А. М., Марченко А. В., Хапаев С. А. Реконструктивная хирургия постинфарктных аневризм левого желудочка. – Новосибирск: Издательство СО РАН, филиал «Гео», 2003. – 179c.
  8. Чернявский А. М., Марченко А. В. и др. Реконструктивная хирургия постинфарктных аневризм левого желудочка сердца. Патология кровообращения и кардиохирургия. 2000;1–2:30–5.
  9. Чернявский А. М., Хапаев С. А., Марченко А. В. и др. Отдален­ные результаты реконструктивных операций при постинфаркт­ных аневризмах левого желудочка. Патология кровообращения и кардиохирургия. 2011;4:33–8.
  10. Almeida RM. Surgical reverse remodelling of the left ventricle: 111 months of follow-up. Rev Bras Cir Cardiovasc. 2009 Oct-Dec;24 (4):470–7.
  11. Ahn HS, Kim HK, Park EA et al. Isolated, broad-based apical diverticulum: cardiac magnetic resonance is a «terminator» of cardiac imaging modality for the evaluation of cardiac apex. Korean Circ J. 2013 Oct;43 (10):702–4.
  12. Driessen MM, Kort E, Cramer MJ et al. Assessment of LV ejection fraction using real-time 3D echocardiography in daily practice: direct comparison of the volumetric and speckle tracking metho­dologies to CMR. Neth Heart J. 2014 Sep;22 (9):383–90.
  13. Hüther J, Doenst T, Nitzsche S et al. Cardiac magnetic resonance imaging for the assessment of ventricular function, geometry, and viability before and after surgical ventricular reconstruction. J Thorac Cardiovasc Surg. 2011 Dec;142 (6):1515–22.
  14. Yun H, Zeng MS, Jin H et al. Isolated noncompaction of ventricular myocardium: a magnetic resonance imaging study of 11 patients. Korean J Radiol. 2011 Nov-Dec;12 (6):686–92.
  15. Allman KC, Shaw LJ, Hachamovitch R, Udelson JE. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. J Am Coll Cardiol. 2002 Apr 3;39 (7):1151–8.
  16. Стукалова О. В., Синицын В. Е., Терновой С. К. Оценка миокарда у больных ИБС с помощью контрастной МРТ. Медицинская визуализация. 2004;5:18–23.
  17. Sanstede JJ. Assessment of myocardial viability by MR imaging. Eur Radiol. 2003 Jan;13 (1):52–61.
  18. Van Assche LM, Kim HW, Kim RJ. Cardiac MR for the assessment of myocardial viability. Methodist Debakey Cardiovasc J. 2013 Jul-Sep;9 (3):163–8.
  19. Sawada S, Bapat A, Vaz D et al. Incremental value of myocardial viability for prediction of long-term prognosis in surgically revascularized patients with left ventricular disfunction. J Am Coll Cardiol. 2003 Dec 17;42 (12):2099–105.
  20. Caldeira C, McCarthy PM. A simple method of left ventricular reconstruction without patch for ischemic cardiomyopathy. Ann Thorac Surg. 2001 Dec;72 (6):2148–9.
  21. Petrank YF, Azhari H, Lessick J et al. Effect of aneurysmectomy on left ventricular shape and function: case studies. Med Eng Phys. 1999 Oct;21 (8):547–54.
Chernyavsky A. M., Denisova M. A., Kareva Yu. E. et al. Comparative characteristics of the left ventricle preoperative modeling based on data of echocardiography and magnetic resonance tomography. Russian Heart Failure Journal. 2015;16 (2):67–71

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