Establishment of a chronic left ventricular aneurysm model in rabbit

Objectives To establish a cost-effective and reproducible procedure for induction of chronic left ventricular aneurysm （LVA） in rabbits. Methods Acute myocardial infarction （AMI） was induced in 35 rabbits via concomitant ligation of the left anterior descending （LAD） coronary artery and the circumflex （Cx） branch at the middle portion. Development of AMI was co n-firmed by ST segment elevation and akinesis of the occluded area. Echocardiography, pathological evaluation, and agar i n-tra-chamber casting were utilized to validate the formation of LVA four weeks after the surgery. Left ventricular end systolic pressure （LVESP） and diastolic pressure （LVEDP） were measured before, immediately after and four weeks after ligation. D i-mensions of the ventricular chamber, thickness of the interventricular septum （IVS） and the left ventricular posterior wall （LVPW） left ventricular end diastolic volume （LVEDV） and systolic volume （LVESV）, and ejection fraction （EF） were recorded by echo-cardiography. Results Thirty one （88.6%） rabbits survived myocardial infarction and 26 of them developed aneurysm （83.9%）. The mean area of aneurysm was 33.4% ＆#177; 2.4% of the left ventricle. LVEF markedly decreased after LVA formation, whereas LVEDV, LVESV and the thickness of IVS as well as the dimension of ventricular chamber from apex to mitral valve annulus significantly increased. LVESP immediately dropped after ligation and recovered to a small extent after LVA formation. LVEDP progressively increased after ligation till LVA formation. Areas in the left ventricle （LV） that underwent fibrosis included the apex, anterior wall and lateral wall but not IVS. Agar intra-chamber cast showed that the bulging of LV wall was prominent in the area of aneurysm. Conclusions Ligation of LAD and Cx at the middle portion could induce develo pment of LVA at a mean area ratio of 33.4%＆#177;2.4%which involves the apex, anterior wall and lateral wall of the LV.

An Extraordinary Case of Silent Extensive Anterior Wall Myocardial Infarction Complicated with Giant Left Ventricular Aneurysm and Dressler Syndrome

Early post-acute myocardial infarction (AMI) pericarditis, pericardial effusion with or without cardiac tamponade, and late post-MI pericarditis (Dressler syndrome), are the major pericardial complications after AMI. It is quite rare and estimated to be only about 0.1% in AMI patients according to a recent report, so it is easily neglected or misdiagnosed and may have tragic result to patient. Clinical features of this post-AMI complication include fever, chest pain, pericarditis and pleurisy occurring 2 to 3 weeks after AMI. Dressler syndrome is rarely associated with left ventricular aneurysm. Contrast enhanced magnetic resonance and echocardiography play important roles in diagnosis of left ventricle aneurysm. We report a 54-year-old male heavy labor worker who had asymptomatic, severe coronary artery disease, complicated with silent myocardial infarction, which resulted in large left ventricular aneurysm, and also systolic heart failure was noted. Patient was diagnosed to have Dressler syndrome after his second cardiology clinic follow-up. He received coronary angiography which revealed triple vessel disease with total occlusion of left anterior descending artery, and a giant left ventricular aneurysm was found. He received surgical intervention with Batista method and followed-up uneventfully at the cardiology clinic.

Giant and thrombosed left ventricular aneurysm

Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur,including heart failure,thromboembolism,or tachyarrhythmias. We report the case of a 78-yearold male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded,and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm,causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention.

Ventricular Septal Defect and Left Ventricular Aneurysm After Acute Myocardial Infarction

The combination of an acute ventricular septal defect (VSD) and left ventricular aneurysm (LVA) is a rare, life-threatening complication which usually occurs within the first week following acute myocardial infarct- tion (AMI). We describe the case of an apical VSD and LVA in a 77-year-old diabetic and dyslipidemic male patient after anterior AMI. The patient was an active smoker and had a history of chronic obstructive pulmonary disease, arterial hypertension and atrial fibrillation. The patient underwent ventriculotomy for VSD repair using a large equine pericardial patch followed by intraventricular patch remodelling of the LVA. He was discharged 2 months after surgery and underwent a successful hip replacement 10 months later.

Management of Left Ventricular Aneurysm: A Study from Iraq

Background: The most appropriate surgical approach for post-myocardial infarction left ventricular aneurysm (LVA) is controversial. This study aims to display the results of surgical treatment of LVA in a major Iraqi cardiac surgical center. Methods: The surgical management of LVAs over the period 2001 to 2011 was retrospectively reviewed. The presenting signs and symptoms, results of investigations, operative findings, and outcomes of patients were determined. Results: Twenty-seven true LVAs associated with 4 ventricular septal defects (VSDs) were treated surgically. During the same period, 1136 coronary artery bypass graft (CABG) operations were done, thus LVA represented 2.4%. Males constituted the majority (74.1%). The mean age was 54.6 years old. The typical ECG changes were seen in 42.1%. Apical and antero-apical locations predominated. The majority of patients (84.2%) had subnormal values of ejection fraction (EF). Most patients had multi-vessel coronary artery disease (CAD). The most frequent was the left anterior descending artery (LAD). All patients had CABG except 3. Linear repair and Dor technique were used equally. The commonest postoperative complication was bleeding (38.4%). The overall hospital mortality was 18.5%. Conclusion: Concomitant CABG improves early postoperative course and must be added when significant lesions in coronary arteries particularly the LAD are present.

Epicardial radiofrequency ablation for left ventricular aneurysm related ventricular arrhythmias during off-pump coronary artery bypass surgery

Background Left ventricular aneurysm （LVA） is one of the serious complications after acute myocardial infarction. We attempted to evaluate the preliminary efficacy of LVA repair combined with epicardial radiofrequency ablation for ventricular arrhythmia during off-pump coronary artery bypass grafting （OPCAB）.

Surgery for left ventricular aneurysm after myocardial infarction： techniques selection and results assessment

Background The most appropriate surgical approach for patients with post-infarction left ventricular （LV） aneurysm remains undetermined. We compared the efficacy of the linear versus patch repair techniques, and investigated the mid-term changes of LV geometry and cardiac function, for repair of LV aneurysms. Methods We reviewed the records of 194 patients who had surgery for a post-infarction LV aneurysm between 1998 and 2010. Short-term and mid-term outcomes, including complications, cardiac function and mortality, were assessed. LV end-diastolic and systolic dimensions （LVEDD and LVESD）, LV end-diastolic and end-systolic volume indexes （LVEDVI and LVESVI） and LV ejection fraction （LVEF） were measured on pre-operative and follow-up echocardiography. Results Overall in-hospital mortality was 4.12%, and major morbidity showed no significant differences between the two groups. Multivariate analysis identified preoperative left ventricular end diastolic pressure 〉20 mmHg, low cardiac output and aortic clamping time 〉2 hours as risk factors for early mortality. Follow-up revealed that LVEF improved from 37% pre-operation to 45% 12 months post-operation in the patch group （P=0.008）, and from 44% pre-operation to 40% 12 months postoperation in the linear group （P=0.032）. In contrast, the LVEDVI and LVESVI in the linear group were significantly reduced immediately after the operation, and increased again at follow-up. However, in the patch group, the LVEDVI and LVESVI were significantly reduced at follow-up. And there were significant differences in the correct value changes of LVEF and left ventricular remodeling between linear repair and patch groups. Conclusions Persistent reduction of LV dimensions after the patch repair procedure seems to be a procedure-related problem. The choice of the technique should be tailored on an individual basis and surgeon＇s preference. The patch remodeling technique results in a better LVEF improvement, further significant reductions in LV dimensions and volumes than does the linear repair technique. The results suggest that LV patch remodeling is a better surgical choice for patients with post-infarction LV aneurysm.

A Procedure of Combination of Sequential Internal Thoracic Artery Grafting and Cooley's Technique for Complicated Case With Multi-vessel Disease,Left Ventricular Aneurysm and Mitral Regurgitation

INTRODUCTIONLeft ventricular aneurysm and ischemic mitral regurgitation are two of most common complications of acute myocardial infarction （AMI）. Combination of both these two fatal complications is not rare and the management of these complicated cases is always a challenge to cardiac surgeon because of its relatively high mortality. We reported a rare case of AMI in which a singlestage correction of mitral valve replacement with preservation of mitral apparatus, sequential left internal thoracic artery （ITA） grafting and Cooley＇s technique.

Left ventricular pseudoaneurysm: A case report and review of the literature

Left ventricular(LV) pseudoaneurysm is a rare complication that is reported in less than 0.1% of all patients with myocardial infarction. It is the result of cardiac rupture contained by the pericardium and is characterized by the absence of myocardial tissue in its wall unlike true aneurysm which involves full thickness of the cardiac wall. The clinical presentation of these patients is nonspecific, making the diagnosis challenging. Transthoracic echocardiogram and cardiac magnetic resonance imaging are the noninvasive modalities whereas coronary arteriography and left ventriculography are invasive modalities used for the diagnosis. As this condition is lethal, prompt diagnosis and timely management is vital.

Advanced Anderson-Fabry disease presenting with left ventricular apical aneurysm and ventricular tachycardia

A 54-year-old female with Anderson-Fabry disease(AFD)-R342 Q missense mutation on exon 7 in alphagalactosidase A(GLA) gene- presented with sustained ventricular tachycardia. Imaging confirmed the presence of a new left ventricular apical aneurysm(LVAA) and a significantly reduced intra-cavitary gradient compared to two years prior. AFDcv is an X-linked lysosomal storage disorder caused by GLA enzyme deficiency. The phenotypic expression of AFD in the heart is not well described. Cardiac involvement can include left ventricular hypertrophy(LVH), which is typically symmetric, but can also mimic hypertrophic cardiomyopathy(HCM). Left ventricular apical aneurysm is a rare finding in HCM. We suggest a shared mechanism of LVAA formation in AFD and HCM, independent of the underlying cardiomyopathy. Mechanisms of LVAA formation in HCM include genetic predisposition and long-standing left ventricular wall stress from elevated intra-cavitary systolic pressures due to mid-cavitary obstruction. Both mechanisms are supported in this patient(a brother with AFD also developed a small LVAA). Screening for AFD should be considered in cases of unexplained LVH, particularly in patients with the aneurysmal variant of HCM.

Safety and efficacy of amplatzer duct occluder for percutaneous closure of ventricular septal defects with tunnel shape aneurysm: Medium term follow up

Objectives: Different devices including Amplatzer duct occluder has been used for percutaneous closure of ventricular septal defects. This study reports our medium term follow up of perimembranous and muscular ventricular septal defects with tunnel shape aneurysm closure using the Amplatzer duct occluder. Materials and Methods: From May 2006-December 2012, we used Amplatzer duct occluder in seven ventricular septal defect patients here atHamad General Hospital,Doha,Qatar. There were 4 male and 3 female patients with an age range of 4 - 32 years with a median of 8 years and weight range of 16 - 63 kgwith a median of33 kg. In this group, 6 were perimembranous and 1 muscular and all these ventricular septal defects had a tunnel shape aneurysm. Transesophageal echocardiographic diameter ranged from 4 - 8 mmand Qp/Qs was 1 - 1.6. Angiographically, the diameter on the left ventricular side measured 3.5 - 10 mmand on right ventricular side 2.4?- 5 mm. 8/6 mmAmplatzer duct occluder was used to close these ventricular septal defects. Results: There were no major complications and immediately after the procedure there was no residual shunt in any of these patients and all the patients remained in normal sinus rhythm. One patient was expatriate and no further follow up was available. The rest of the 6 patients had 1 - 80 months with a median of 54 months follow up and none of these patients had any residual shunt and all remained in normal sinus rhythm. Two patients developed trivial aortic valve regurgitation immediate post procedure, one remained unchanged and the 2nd has progressed to mild at this latest follow up. Conclusion: Amplatzer duct occluder is feasible and a safe device for percutaneous closure of selective tunnel shape aneurysmal perimembranous and muscular ventricular septal defects.

Septic Pulmonary Emboli and Right Ventricular Obstruction in a Membranous Interventricular Septal Aneurysm

Although the majority of patients with perimembranous ventricular septal defect and septal aneurysm remained asymptomatic, some of them presented with serious complications during adulthood and thus required high risky surgery. In accordance with other rare condition, the incidence and natural history have not been well documented. This case describes the occurrence of a septic pulmonary emboli associated with right ventricular outflow tract obstruction in a young child.

Ventricular Tachycardia Unveiling an Obstructive Cardiomyopathy Complicated with an Apical Aneurysm

Background: We report the case of a 58-year-old hypertensive patient under treatment who presented with a ventricular tachycardia unveiling an obstructive cardiomyopathy complicated with an apical aneurysm. Aim: Highlight the rarity of the case and the difficulty of management. Case Presentation: This patient was transferred from Regional Hospital of Ziguinchor in southern Senegal for a brutal dizzy spell without loss of consciousness. The electrocardiogram showed a wide monomorphic QRS complex regular tachycardia with a rate of 215 beats/min. An external electrical cardio version at 300 joules was applied which led to the recovery of a sinus rhythm on the electrocardiogram. The Doppler echocardiography showed an asymetricalmedio-ventricular hypertrophy with a maximum left intraventricular gradient at 10 mm Hg at rest. The coronarography via the radial artery was normal. The evolution was labeled with a recurrence of the ventricular tachycardia. The patient was then put on amiodarone 200 mg, beta-blocker (bisoprolol 10 mg) and anti-vitamin K (acenocoumarol 4 mg). Facing rhythmic instability, an implantable automatic defibrillator was fitted. No complication has been reported after one year of evolution. Conclusion: HCM with medio ventricular obstruction and apical aneurysm complicated with ventricular arrhythmias is a rare entity. Its management is difficult and controversial.

Electro-Anatomical Approach to Membranous Septal Aneurysm: Potential as a Focus of Critical Ventricular Arrhythmias

Membranous septal aneurysm (MSA) is a rare anomaly and known to cause ventricular tachycardia and atrioventricular block. However, underlying mechanisms have not been addressed in its long history. We report first 3-D electro-anatomical mapping of MSA during and three years following the surgery. An elderly patient underwent a surgery for MSA. In the mapping, we located the His bundle near MSA and observed delayed potentials around MSA. Our report showed that electrophysiological character of myocardium was changed around MSA and this change might be a reason for ventricular tachycardia and atrioventricular block. An ordinary surgery for MSA might not resolve this problem since we still observed delayed potentials three years after the surgery.

Aortic Sinus of Valsalva Aneurysm Isolation by Radiofrequency Ablation in Outflow Tract Ventricular Tachycardia

Idiopathic monomorphic ventricular tachycardia and premature ventricular complexes (PVCs) commonly arise from the right and left ventricular outflow tracts (VOT). Their mechanism is most commonly triggered activity from delayed after-depolarizations and successful ablation is performed at the site of earliest endocardial activation. Re-entrant mechanisms have been rarely described. We report a case of an otherwise healthy patient who ultimately underwent six electro-physiology studies (EPS) and suffered numerous implantable cardiac defibrillator (ICD) discharges prior to the successful radiofrequency ablation (RFA) of two idiopathic VOT tachycardias. During the sixth EPS, a proximal aortogram demonstrated a left aortic sinus of valsalva (LASV) aneurysm. Subsequntly, a novel and successful RFA strategy of aneurysm isolation was undertaken. The presence of multiple clinical or inducible VT morphologies and the characterization of a VT as re-entrant should raise concerns that a complex arrhythmogenic substrate is present and defining the anatomy with angiography or an alternative imaging modality is essential in achieving a successful ablation strategy.

Progressive deterioration of left ventricular function in a patient with a normal coronary angiogram

Cardiac ischemia with a normal coronary angiogram can be caused by coronary microvascular dysfunction.A favorable prognosis,with excellent long-term clinical outcome,without major acute coronary events,has been consistently reported in these patients.We report a patient with a normal coronary angiogram and 3 episodes of myocardial infarctions,where the formation of a ventricular aneurysm and progressive deterioration of left ventricular function was documented,and hypoperfusion of the myocardium was confirmed by cardiovascular magnetic resonance imaging,This case suggests that myocardial ischemia caused by coronary microvascular dysfunction could have a poor prognosis.Whether this case represents a special clinical condition which is between the cardiac syndrome X and coronary artery disease remains to be investigated.

新型口服抗凝药对急性心肌梗死后心力衰竭合并室壁瘤附壁血栓消退影响的研究

目的:探讨新型口服抗凝药(novel oral anticoagulants,NOAC)用于治疗急性心肌梗死(acute myocardial infarction,AMI)后心力衰竭合并室壁瘤内附壁血栓的疗效。方法:入选2019年6月至2023年5月,首都医科大学附属北京安贞医院心内科门诊和病房患者中AMI后发生心力衰竭合并室壁瘤内附壁血栓患者118例,分别给予NOAC(NOAC组,65例)或维生素K受体拮抗剂(VKA组,53例)治疗,3个月后复查经胸超声心动图,如血栓尚未完全溶解,则在首次给药6个月后再次复查超声心动图。结果:NOAC组中,使用利伐沙班治疗者为46例,使用达比加群治疗者为19例,治疗3个月后血栓完全溶解率为70.8%。所有VKA组患者均使用华法林治疗,3个月后血栓完全溶解率为67.9%,与NOAC组相比差异无统计学意义(P>0.05)。治疗6个月后,NOAC组的血栓完全溶解率为90.8%,VKA组的血栓完全溶解率为84.9%,两组血栓溶解率对比差异无统计学意义(P>0.05)。结论:NOAC可考虑作为AMI后心力衰竭合并室壁瘤内附壁血栓消退的治疗药物,且无须监测INR,使用方便,安全性好。

Double-chambered left ventricle with a thrombus in an asymptomatic patient:A case report

BACKGROUND Double-chambered left ventricle(DCLV)is an extremely rare congenital disease in which the left ventricle(LV)is divided by abnormal muscle tissue.Due to its rarity,there is a lack of data on the disease,including its diagnosis,treatment,and prognosis.Accordingly,we report a case in which DCLV was diagnosed and followed up.CASE SUMMARY A 45-year-old man presented to our hospital due to abnormal findings on an electrocardiogram recorded during a health check.He had no specific cardiac symptoms,comorbidities or relevant past medical history.Echocardiography revealed that the LV was divided into two by muscle fibers.There were no findings of ischemia on coronary angiography and coronary computed tomography angiography performed to exclude differential diagnoses.After comprehensive analysis of the images,DCLV was diagnosed.As it seemed to be asymptomatic DCLV,we decided the patient was to be observed without administering any medication.However,follow-up echocardiography revealed a thrombus in the accessory chamber(AC).Anticoagulant medication was initiated,the thrombus resolved,and the patient is currently undergoing follow-up without any specific symptoms.CONCLUSION Asymptomatic,uncomplicated DCLV was diagnosed through multimodal imaging;however,a thrombus in the AC occurred during the follow-up.The findings highlight that multimodal imaging is essential in diagnosing DCLV,and that anticoagulation is important in its management.

动脉瘤性蛛网膜下腔出血并发急性脑积水的危险因素分析及预测模型构建

目的评估动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)并发急性脑积水(acute hydrocephalus,AHC)的危险因素,并构建预测模型。方法回顾性分析2015年1月至2024年1月秦皇岛市第一医院神经外科收治的aSAH患者的临床资料。按照7∶3比例,将aSAH患者随机分为训练集和验证集,根据是否发生AHC分为AHC组和非AHC组,训练集用于构建AHC风险预测模型,验证集用于验证AHC风险预测模型,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)及其曲线下面积(area under curve,AUC)、校准曲线和决策曲线验证风险预测模型的可靠性和稳定性。结果共纳入1062例aSAH患者,其中324例患者发生AHC,发生率为30.51%。训练集、验证集分别有患者744、318例。多因素Logistic回归显示年龄≥60岁[OR=3.067,95%CI(1.710,5.499)]、破入脑室[OR=7.039,95%CI(3.792,13.068)]、Fisher分级为IV级[OR=3.371,95%CI(1.335,8.514)]、Hunt-Hess分级为IV级[OR=6.198,95%CI(2.218,17.324)]和高水平神经元特异性烯醇化酶[OR=1.746,95%CI(1.581,1.928)]是aSAH患者发生AHC的独立危险因素(P<0.05),而动脉瘤位于前循环[OR=0.397,95%CI(0.199,0.790)]是aSAH患者发生AHC的的独立保护因素(P<0.05)。训练集和验证集的AUC(95%CI)分别为0.950(0.932,0.967)和0.969(0.955,0.982);校准曲线显示“预测AHC概率”和“实际AHC概率”吻合;决策曲线均提示AHC风险预测模型临床净获益高于“全部”临床净获益。结论临床工作中应重点关注年龄≥60岁、破入脑室、Fisher分级与Hunt-Hess分级为IV级和高水平神经元特异性烯醇化酶aSAH患者AHC的发生风险,本研究构建的AHC预测模型可为早期识别AHC提供便捷工具。