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Surgical cryoablation of drug resistant ventricular tachycardia and aneurysmectomy of postinfarction left ventricular aneurysm.

Pojar M, Harrer J, Omran N, Vobornik M - Case Rep Med (2014)

Bottom Line: Heart failure is usually associated with left ventricle remodelling, wall thickening, and worsening of the systolic function.The authors present a case of a 51-year-old man with ischemic heart disease, who suffered myocardial infarction four years ago.The patient remained free of any ventricular tachycardia four months later.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiac Surgery, Faculty of Medicine and University Hospital, Charles University in Prague, Sokolska 581, 500 05 Hradec Kralove, Czech Republic.

ABSTRACT
Heart failure is usually associated with left ventricle remodelling, wall thickening, and worsening of the systolic function. Ventricular tachycardia is a common and a negative prognostic factor in patients with endocardial scarring following myocardial infarction and aneurysm formation. The authors present a case of a 51-year-old man with ischemic heart disease, who suffered myocardial infarction four years ago. The patient was admitted to the hospital with sustained ventricular tachycardia despite maximal pharmacotherapy and also underwent unsuccessful percutaneous radiofrequency ablation in the right ventricle. Transthoracic echocardiography revealed left ventricle dysfunction with ejection fraction of 25%, aneurysm of the apex of the left ventricle with thrombus formation inside the aneurysm. Surgical therapy consisted of the cryoablation applied at the transitional zone of the scar and viable tissue and the resection of the aneurysm. The patient remained free of any ventricular tachycardia four months later.

No MeSH data available.


Related in: MedlinePlus

Perioperative view shows the left ventricle. After the left ventricular aneurysm was opened the transitional zone was identified. Encircling cryoablation of transitional zone between the scar and viable tissue (arrow).
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fig2: Perioperative view shows the left ventricle. After the left ventricular aneurysm was opened the transitional zone was identified. Encircling cryoablation of transitional zone between the scar and viable tissue (arrow).

Mentions: The surgery procedure was carried out via median sternotomy. Cardiopulmonary bypass was established via cannulation of the ascending aorta and right atrium. The aorta was cross-clamped, and myocardial protection was achieved with intermittent cold antegrade blood cardioplegia. The left ventricle was incised parallel to the interventricular septum and the left anterior descending artery. The interventricular clots were removed. Continuous encircling linear cryolesions (CryoICE, AtriCure, Ohio, USA) were applied at the transitional zone of the scar and viable tissue (Figure 2). The left ventricle restoration was performed according to the procedure described by Dor. A purse-string suture was placed around the circumference of the scar at the transition zone and tied down to determine the size of the ventricle diameter. A prosthetic patch was then secured over ventricular opening and the free wall edges were closed over the patch. The postoperative course was uncomplicated and the patient was discharged 15 days later. Only β-blocker (metoprolol, Betaloc ZOK, AstraZeneca, Great Britain) was given in the postoperative period. In the period of four-month followup no recurrent ventricular tachycardia was detected. According to the ICD no VT was detected in the follow-up period, and only paroxysmal supraventricular tachycardia was detected. Transthoracic echocardiography showed improvement in the ejection fraction of the left ventricle (45%) and no signs of thrombus.


Surgical cryoablation of drug resistant ventricular tachycardia and aneurysmectomy of postinfarction left ventricular aneurysm.

Pojar M, Harrer J, Omran N, Vobornik M - Case Rep Med (2014)

Perioperative view shows the left ventricle. After the left ventricular aneurysm was opened the transitional zone was identified. Encircling cryoablation of transitional zone between the scar and viable tissue (arrow).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150409&req=5

fig2: Perioperative view shows the left ventricle. After the left ventricular aneurysm was opened the transitional zone was identified. Encircling cryoablation of transitional zone between the scar and viable tissue (arrow).
Mentions: The surgery procedure was carried out via median sternotomy. Cardiopulmonary bypass was established via cannulation of the ascending aorta and right atrium. The aorta was cross-clamped, and myocardial protection was achieved with intermittent cold antegrade blood cardioplegia. The left ventricle was incised parallel to the interventricular septum and the left anterior descending artery. The interventricular clots were removed. Continuous encircling linear cryolesions (CryoICE, AtriCure, Ohio, USA) were applied at the transitional zone of the scar and viable tissue (Figure 2). The left ventricle restoration was performed according to the procedure described by Dor. A purse-string suture was placed around the circumference of the scar at the transition zone and tied down to determine the size of the ventricle diameter. A prosthetic patch was then secured over ventricular opening and the free wall edges were closed over the patch. The postoperative course was uncomplicated and the patient was discharged 15 days later. Only β-blocker (metoprolol, Betaloc ZOK, AstraZeneca, Great Britain) was given in the postoperative period. In the period of four-month followup no recurrent ventricular tachycardia was detected. According to the ICD no VT was detected in the follow-up period, and only paroxysmal supraventricular tachycardia was detected. Transthoracic echocardiography showed improvement in the ejection fraction of the left ventricle (45%) and no signs of thrombus.

Bottom Line: Heart failure is usually associated with left ventricle remodelling, wall thickening, and worsening of the systolic function.The authors present a case of a 51-year-old man with ischemic heart disease, who suffered myocardial infarction four years ago.The patient remained free of any ventricular tachycardia four months later.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiac Surgery, Faculty of Medicine and University Hospital, Charles University in Prague, Sokolska 581, 500 05 Hradec Kralove, Czech Republic.

ABSTRACT
Heart failure is usually associated with left ventricle remodelling, wall thickening, and worsening of the systolic function. Ventricular tachycardia is a common and a negative prognostic factor in patients with endocardial scarring following myocardial infarction and aneurysm formation. The authors present a case of a 51-year-old man with ischemic heart disease, who suffered myocardial infarction four years ago. The patient was admitted to the hospital with sustained ventricular tachycardia despite maximal pharmacotherapy and also underwent unsuccessful percutaneous radiofrequency ablation in the right ventricle. Transthoracic echocardiography revealed left ventricle dysfunction with ejection fraction of 25%, aneurysm of the apex of the left ventricle with thrombus formation inside the aneurysm. Surgical therapy consisted of the cryoablation applied at the transitional zone of the scar and viable tissue and the resection of the aneurysm. The patient remained free of any ventricular tachycardia four months later.

No MeSH data available.


Related in: MedlinePlus