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Revista Brasileira de Cirurgia Cardiovascular

Print version ISSN 0102-7638

Rev Bras Cir Cardiovasc vol.6 no.2 São José do Rio Preto May/Aug. 1991

http://dx.doi.org/10.1590/S0102-76381991000200007 

ARTIGOS ORIGINAIS

 

Tratamento cirúrgico dos aneurismas de ventrículo esquerdo com reconstrução geométrica: aspectos cirúrgicos e resultados imediatos

 

Left ventricular aneurysmectomy with geometric reconstruction: surgical aspects and immediate results

 

 

Gilmar Geraldo dos SantosI; Victor L. S. HaddadI; Silas F. Avelar Jr.; Antônio Amauri Groppo; Ricardo BeyrutiI; Rosa Maria SimõesI; Noedir A. G. StolfI

IDa Unidade de Doenças Torácicas (Serviço Prof. Noedir Stolf). Hospital da Beneficência Portuguesa

Endereço para separatas

 

 


RESUMO

Os resultados imediatos de 79 pacientes operados num período de sete anos para tratamento cirúrgico de aneurisma de ventrículo esquerdo com a técnica de reconstrução geométrica circular são analisados. A indicação cirúrgica mais freqüente foi a insuficiência cardíaca congestiva (78,4%), isolada (25,3%) ou associada à insuficiência coronária (53,1%). Sessenta (76%) pacientes estavam em classe funcional III e 10 (12,6%) em classe funcional IV. Cinqüenta e oito (73,4%) pacientes foram submetidos à revascularização do miocárdio concomitantemente. A mortalidade hospitalar foi de 5,1% e teve incidência maior nos pacientes com idade acima de 60 (12%) anos, em classe funcional IV (20%), com má função ventricular (FE < 0,30 - 20% e PDfVE > 25 - 14%) e lesões coronárias triarteriais (10%). Estes fatores também estiveram associados a complicações cardíacas com baixo débito e uso de BIA. Outros fatores de risco citados na literatura são discutidos. Os resultados imediatos desse estudo e os resultados imediatos e tardios de outros em que a técnica usada foi semelhante são melhores que os obtidos com outros tipos de correção e sugerem ser este o procedimento de escolha para o tratamento dessa afecção.

Descritores: aneurismas de ventrículo esquerdo, cirurgia, reconstrução geométrica.


ABSTRACT

The early results of 79 patients who underwent left ventricular aneurysmectomy with the geometric and circular reconstruction in a seven years experience are analyzed. The most common indication for operation was congestive heart failure (78.4%), isolated (25.3%) or with coronary artery disease (53.1%). Sixty (76%) patients were in NYHA class III and 10 (12.6%) in NYHA class IV at the time of surgery. Fifty eight (73.4%) underwent coronary artery bypass graft surgery. Hospital mortality was 5.1% and patients older than 60 (12%), in NYHA class IV (20%), with poor left ventricular function (FE < 0.30 - 20% and LVEDP > 25 - 14%) and extensive coronary artery disease (10%) were under increased risk. Low cardiac output and use of IABP were also associate with this risk factors. Other factors of increased risk pointed in the literature are discussed. There were no deaths for isolated left ventricular aneurysmectomy. The early results of this study and the early and late results from others using the same technique are better than that obtained by others with different types of correction and they suggest that this is the procedure of choice to treat left ventricular aneurysm.

Descriptors: aneurysms of left ventricle, surgery, geometric reconstruction.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

REFERÊNCIAS BIBLIOGRÁFICAS

1 ABRAMS, D. L.; EDELIST, A.; LURIA, M. H.; MILLER, A. J. - Ventricular aneurysm: a reappraisal based on a study of sixty-five consecutive autopsied cases. Circulation, 27: 164-169, 1963.         [ Links ]

2 AKINS, C. W. - Resection of left ventricular aneurysm during hipotermic fibrillatory arrest without aortic occlusion. J. Thorac. Cardiovasc. Surg., 91: 610-618, 1986.         [ Links ]

3 BARRATT-BOYES, B. G.; WHITE, H. D.; AGNEW, T. M.; PEMBERTON, J. R.; WILD, C. J. - The results of surgical treatment of left ventricular aneurysms: an assessment of the risk factors affecting early and late mortality. J. Thorac. Cardiovasc. Surg., 87: 87-98, 1984.         [ Links ]

4 BRAWLEY, R. K.; MAGOVERN, C. J.; GOTT, V. L; DONAHOO, J. S.; GARDNER, T. J.; WATKINS, L. - Left ventricular aneurysmectomy: factors influencing postoperative results. J. Thorac. Cardiovasc Surg., 85: 712-717, 1983.         [ Links ]

5 BURTON, N. A.; STINSON, E. B.; OYER, P. E.; SHUMWAY, N. E. - Left ventricular aneurysm: preoperative risk factors and long-term postoperative results. J. Thorac. Cardiovasc. Surg., 77: 65-75, 1979.         [ Links ]

6 COHEN, M.; PACKER, M.; GOLIN, R. - Indications for left ventricular aneurysmectomy. Circulation, 67: 712-722, 1983.         [ Links ]

7 COOLEY, D. A.; COLLINS, H. A.; MORRIS, G. C. - Left ventricular aneurysm after myocardial infarction: surgical excision with use of temporary cardiopulmonary bypass. JAMA, 167: 557-580, 1958.         [ Links ]

8 GOSGROVE, D. M.; LOOP, E. D.; IRARRAZAVAL, M. J.; GROVES, L. K.; TAYLOR, P. C.; GOLDING, L. A. - Determinants of longterm survival after ventricular aneurysmectomy. Ann. Thorac. Surg., 26: 357-363, 1978.         [ Links ]

9 COSGROVE, D. M.; LYTLE, B. W.; TAYLOR, P. C.; STEWART, R. W.; GOLDING, L. A. R.; MAHFOOD, S.; GOORMASTIC, M.; LOOP, F. D. - Ventricular aneurysm resection: trends in surgical risk. Circulation, 79 (Supl. 1): 97-101, 1989.         [ Links ]

10 CROSBY, I. K.; WELLONS, H. A.; MARTIN, R. P.; SCHUCH, D.; MULLER, W. H. - Employability: a new indication for aneurysmectomy and coronary revascularization. Circulation, 62 (Supl. 1): 79-83, 1980.         [ Links ]

11 DAVIS, R. W. & EBERT, P. A. - Ventricular aneurysm: a clinical-pathologic correlation. Am. J. Cardiol., 29: 1-6, 1972.         [ Links ]

12 DOR, V.; SAAB, M.; COSTE, P.; KORNASZEWSKA, M.; MONTIGLIO, F. - Left ventricular aneurysm: a new surgical approach. Thorac. Cardiovasc. Surg., 37: 11-19, 1989.         [ Links ]

13 FAXON, D. P.; RYAN, T. J.; DAVIS, K. B.; McCABE, C. H.; MEYRS, W.; LESPERANCE, J.; SHAW, R.; TONG, T. G. - Prognostic significance of angiographically documented left ventricular aneurysm from the coronary artery surgery study (CASS). Am. J. Cardiol., 50: 157-164, 1982.         [ Links ]

14 GONZALES-SANTOS, J. M.; ENNABLI, K.; GALINANES, X.; BOSH, J.; LESPERANCE, J.; PELLETIER, L. C. - Surgical treatment of the post-infarction left ventricular aneurysm: factors influencing early and late results. Thorac. Cardiovasc. Surg., 33: 86-93, 1985.         [ Links ]

15 GORLIN, R.; KLIEN, M. D.; SULLIVAN, J. M. - Mechanistic concept and clinical recognition. Am. J. Med., 42: 512-523, 1967.         [ Links ]

16 HARKEN, A. H.; HOROWTZ, L. N.; JOSEPHSON, M. E. - Comparison of standard aneurysmectomy with directed endocardial resection for the treatment of recurrent sustained ventricular tachycardia. J. Thorac. Cardiovasc Surg., 80: 527-534, 1980.         [ Links ]

17 HUTCHING, G. M. & BRAWLEY, R. D. - The influence of cardiac geometry on the result of ventricular aneurysm repair. Am. J. Pathol., 99: 221-228, 1980.         [ Links ]

18 JATENE, A. D. - Left ventricular aneurysmectomy: ressection or reconstruction. J. Thorac. Cardiovasc. Surg., 89: 321-331, 1985.         [ Links ]

19 JONES, E. L.; CRAVER, J. M.; HURST, J. W.; BRADFORD, J. A.; BONE, D. K.; ROBINSON, P. H.; COBBS, B. W.; THOMPKINS, T. R.; HATCHER Jr., C. R. - Influence of left ventricular aneurysm on survival following the coronary artery bypass operation. Ann. Surg., 193: 733-742, 1981.         [ Links ]

20 LEFEMINE, A. A.; GROVINDARAJAN, R.; RAMASWAMY, D.; BLACK, H.; MALDOFF, I.; SANELLA, N. - Left ventricular ressection for aneurysm and akinesia due to coronary artery disease: fifty consecutive patients. Ann. Thorac. Surg., 23: 461-466, 1977.         [ Links ]

21 LOUAGIE, Y.; ALOUINI, T.; LESPERANCE, J.; PELLETIER, L. C. - Left ventricular aneurysm with predominating congestive heart failure: a comparative study of medical and surgical treatment. J. Thorac. Cardiovasc. Surg., 94: 571-581, 1987.         [ Links ]

22 MAGOVERN, G. J.; SAKERT, T.; LAUB, G. W.; LIEBLER, G.; BURKHOLDER, J.; BENCKART, D.; MAGOVERN Jr., G. J. - Surgical therapy for left ventricular aneurysms: a ten year experience. Circulation, 79 (Supl. 1): 102-107, 1989.         [ Links ]

23 MORAN, J. M.; SCANLON, P. J.; NEMICKAS, R.; PIFARRÉ, R. - Surgical treatment of post infarction ventricular aneurysm. Ann. Thorac. Surg., 21: 107-112, 1976.         [ Links ]

24 MULLEN, D. C.; POSEY, L.; GABRIEL, R.; SINGH, H. M.; FLEMA, R. J.; LEPLEY, D. - Prognostic considerations in the management of left ventricular aneurysms. Ann. Thorac. Surg., 23: 455-460, 1977.         [ Links ]

25 NAJAFI, H.; MENG, R.; JAVID, H.; HUNTER, J. A.; GOLDIN, M.; MONSON, D. O.; NAJAFI, K. L. - Postmyocardial infarction left ventricular aneurysm. Cardiovasc. Clin., 12: 81-91, 1982.         [ Links ]

26 NICHOLOSI, A. C.; WENG, Z. C.; DETWILER, P. W.; SPOTNITZ, H. M. - Simulated left ventricular aneurysm: an aneurysm repair in swine. J. Thorac. Cardiovasc. Surg., 100: 745-755, 1990.         [ Links ]

27 NOVICK, R. J.; STEFANISZYN, H. J.; MORIN, J. E.; SYMES, J. R.; SNIDERMAN, A. D.; DOBELL, A. R. C. - Surgery for postinfarction left ventricular aneurysm: prognosis and long-term follow-up. Canad. J. Surg., 27: 161-167, 1984.         [ Links ]

28 OKIES, J. E.; DIETL, C.; GARRISON, H. B.; STARR, A. - Early and late results of resection of ventricular aneurysm. J. Thorac. Cardiovasc. Surg., 75: 255-260, 1978.         [ Links ]

29 OLEARCHYK, A. S.; LEMOLE, G. M.; SPAGNA, P. M. - Left ventricular aneurysm. Ten years experience in surgical treatment of 244 cases: improved clinical status, hemodynamics, and long-term longevity. J. Thorac. Cardiovasc. Surg., 88: 544-553, 1984.         [ Links ]

30 RATCLIFFE, P. J.; KAY, P.; OLDERSHAWM P. J. - Long-term survival following left ventricular aneurysmectomy. J. Cardiovasc. Surg., 24: 461-466, 1983.         [ Links ]

31 RIVERA, R. & DELCAN, J. L. - Factors influencing better results in operation for postinfarction ventricular aneurysm. Ann. Thorac. Surg., 27: 445-450, 1979.         [ Links ]

32 SCHLICHTER, J.; HELLERTEIN, H. K.; KATY, L. N. - Aneurysm of the heart: a correlation study of 102 proved cases. Medicine, 33: 42-86, 1954.         [ Links ]

33 SHATTENBERG, T. T.; GUILLANI, E. R.; CAMPION, B. C.; DANIELSON, G. H. - Post-infarction ventricular aneurysm. Mayo Clin. Proc., 45: 13-19, 1970.         [ Links ]

34 STEPHENSON, L. W.; HARGROVE, C. W.; RATCLIFFE, M. B.; EDMUNDS Jr., L. H. - Srugery for left ventricular aneurysm: early survival with and without endocardial resection. Circulation, 79 (Supl. 1): 108-111, 1989.         [ Links ]

35 WALKER, W. E.; STONEY, W. S.; ALFORD, W. C.; BURRUS, G. R.; FRIST, R. A.; GLASSFORD, D. M.; THOMAS, C. S. - Techniques and results of ventricular aneurysmectomy with emphasis on anteroseptal repair. J. Thorac. Cardiovasc. Surg., 76: 824-831, 1978.         [ Links ]

36 WRIGHT, J. S.; STACEY, R. B.; ALBRECHT, H.; MURTON, M. M. - Left ventricular aneurysm surgery: determinants of results. J. Cardiovasc. Surg., 28: 85-88, 1987.         [ Links ]

 

 

Endereço para separatas:
Gilmar Geraldo dos Santos
Rua Maestro Cardim, 769. Sala 227
01323 São Paulo, SP, Brasil

Recebido para publicação em 2 de maio de 1991.

 

 

Trabalho realizado na Unidade de Doenças Torácicas (Serviço Prof. Noedir Stolf). Hospital da Beneficência Portuguesa. São Paulo, SP, Brasil.