A Case of Endoventricular Circular Patch Plasty for Postinfarction Akinetic Aneurysm of Left Ventricle, Associated with Severe Pulmonary Hypertension and Sustained Ventricular Tachycardia

(Department of Cardiovascular Surgery, Saitama Cardiovascular and Respiratory Center, Saitama, Japan and Department of Cardiovascular Surgery, Kawasaki City Hospital*, Kawasaki, Japan)

Motohiro Oshiumi Kazuhiro Hashimoto Tatsuumi Sasaki
Takashi Hachiya Katsuhisa Onoguchi Hiromitsu Takakura
Shigeyuki Takeuchi Kiyokazu Kokaji*
Endoventricular circular patch plasty was performed in a 42-year-old man, with a postinfarction akinetic aneurysm. The case was complicated with severe congestive heart failure, marked pulmonary hypertension (70% of systemic pressure) and sustained ventricular tachycardia. Cardiac catheterization data revealed low ejection fraction (20%), high pulmonary capillary wedge pressure (33mmHg) and high pulmonary arterial pressure (70/33mmHg), associated with enlarged end diastolic volume index (142ml/m2). After the operation, contractile and volumetric improvements were observed, however the severe pulmonary hypertension remained without any improvement. Disappearance of life-threatening arrhythmia allowed his discharge from the hospital, but unsatisfactory hemodynamic data, except for improved ejection fraction to 49%, turned our attention to patient selection and alternative treatment (cardiac transplantation) for such a severe case.
@Jpn. J. Cardiovasc. Surg. 30: 44-47 (2001)