Septal Reshaping for Exclusion of Anteroseptal Dyskinetic Or Akinetic Areas

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Abstract

Background

Our purpose is to describe a technique for exclusion of anteroseptal dyskinetic or akinetic areas.

Methods

From January to December 2002, 22 consecutive patients with myocardial infarction following left anterior descending artery occlusion underwent septal reshaping. All of them were admitted for dyspnea. Eight patients were referred for angina. After a 5 to 8 cm apical incision, 2 U stitches were passed from inside to join the anterior wall to the septum, as high as possible, following the border of the scars. An oval Dacron patch was then sutured from the septum (end of the direct suture through the border with the inferior septum) to the anterior wall (between the healthy and the scarred wall) up to the new apex. Purpose of the procedure is to maintain a longitudinal size as similar as possible to the normal. The incision was closed in a double layer.

Results

No patient died and only one had acute renal failure. No patients had restrictive syndrome. After a mean follow-up of 6.7 ± 3.6 months (3 to 15), mean New York Heart Association Class improved from 2.7 ± 1.1 to 1.2 ± 0.3 (p < 0.001). Echocardiographic results showed reduction of left ventricle volumes and normalization of the stroke volume. In patients with low ejection fraction (≤35%), left ventricular volumes decreased with a concomitant ejection fraction increase and a normal stroke volume. In patients with smaller cavities, significant reduction of left ventricular cavities was also obtained, with similar changes in ejection fraction and normal stroke volume.

Conclusions

This technique treats all the dyskinetic or akinetic areas following left anterior descending artery occlusion, when the septal involvement is higher than the anterior free wall. Clinical and morphologic results are good.

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