EVALUATION OF LEFT VENTRICULAR REMODELING AFTER SURGICAL RECONSTRUCTION OF POSTINFARCTION ANEURYSM

• Published in: Medical Council no. 12; pp. 90 - 98
• Main Authors: Maystrenko, N. S., Sukhova, I. V., Maystrenko, A. D., Nedoshivin, A. O., Gordeev, M. L.
• Format: Journal Article
• Language: English; Russian
• Published: Remedium Group LLC 01.11.2017
• Subjects: brain natriuretic peptide; heart failure; left ventricular aneurism; mitral valve insufficiency; surgical reconstruction of left ventricular aneurism
• ISSN: 2079-701X; 2658-5790
• DOI: 10.21518/2079-701X-2017-12-90-98

Objective: To assess the effect of left ventricle reconstruction in patients with postinfarction aneurysm on remodeling and heart failure dynamics in the immediate and long-term postoperative period. Material and methods: 162 patients with IHD who underwent myocardial infarction and chronic left aneurysm were included in the study. All the patients underwent myocardial revascularization and reconstructive intervention in the LV cavity at the National Medical Research Center named after V.А. Almazov. Two groups of patients were formed, depending on the type of surgical intervention performed. Group 1 (n = 116) included patients who underwent linear plastic surgery of the left ventricle aneurysm. Group 2 (n = 46) identified patients who underwent an intraventricular plastic aneurysm of V. Dor. Results: In the early postoperative period, a statistically significant decrease in the volume of the LV cavity was observed and the global ejection fraction changed in both study groups. In patients with a significant degree of mitral insufficiency additionally did the plastic fibrous ring. The conducted single-factor analysis showed a statistically significant effect of correction of mitral insufficiency on CDD, DAC, and global ejection fraction. The majority of patients in both groups experienced a decrease in LV volumes in the long-term period. Predictors of unfavorable clinical course of heart failure in the long-term period were revealed: violation of contractility at the level of basal parts of the left ventricle with a decrease in the index of violation of local contractility more than 3, ejection fraction less than 35%, uncorrected mitral insufficiency II and more, increased level of natriuretic peptide 4 times from the upper limit of the norm. Conclusions: Combined operation makes it possible to improve the contractive function of left ventricular, to reduce the degree of mitral insufficiency, the functional class of heart failure.