Study of Left Ventricular Function and Myocardial Viability in Patients with Left Ventricular Aneurysm Developed after Myocardial Infarction : A Comparative Study of Medical and Surgical Therapy
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概要
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We evaluated the treatment of left ventricular aneurysm (LVA) caused by myocardial infarction in 44 patients showing cineangiographical features of left ventricular aneurysm.Of the 44 patients, 28 were treated non-surgically (N-S) and 16 were treated surgically (S). Combined aortocoronary bypass graft (ACBG) with aneurysmectomy was performed on 10 patients. Clinical symptoms in LVA patients were angina (34%), congestive heart failure (31.8%), arrhythmia (29.5%), mitral regurgitation. (9%), embolism (4%) and septal perforation (2.3%). Distribution of coronary arterial lesions were single vessel (isolated LAD) 29.5% and multiple vessel 59%. Parameters of LV performance measured at baseline in all LVA patients were: CI 3.05±0.64L/min/m2, LVEDP 19.0±3.5mmHg, LVEDV 200.6±25.9ml, diast. wall stress 50.7±16.8g/cm2, EF 0.46±0.15, LV dp/dt/p 17.8±2.1 S-1, SWI 61±24gm/m2. LV performance after surgery showed clear decreases in LVEDP, LVEDV and wall stress (p<0.05, p<0.02 and p<0.02, respectively). In contrast, EF, LV dp/dt/p and SWI increased significantly (p<0.02, p<0.1 and p<0.01, respectively). Comparison of the results of restudy with first catheterization data in the N-S group showed decreases of EF, contractility index and LV dp/dt/p, each reaching p<0.1. Residual myocardial motion 1 year after the first cineangiographic study showed a significant decrease (-12.8±26.7%) in the N-S group, whereas in the S group it significantly increased to (+60.4±52.7%). A significant difference in coefficient of variation between N-S and S groups was found. Thus, it can be concluded that aneurysmectomy or concomitant myocardial revascularization with aneurysmectomy improves left ventricular diastolic performance and increases residual myocardial viability.
著者
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Yabe Yoshimasa
Cardiovasc. Div. Of Adult Dis. And Dept. Of Radiol. Saiseikai Hosp
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Ito Nobuyuki
The First Dept. Surgery, Toho Univ. Sch. of Med.
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Kamegai Toshihiko
The First Department Of Surgery Toho University School Of Medicine
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KOMATSU Hisashi
The First Department of Surgery, Toho University School of Medicine
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YAMASHITA Toshiharu
Cardiovascular Diagnostic Laboratory Center, Toho University School of Medicine
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KOYAMA Nobuya
The First Department of Surgery, Toho University School of Medicine
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