A CASE OF SUCCESSFUL SURGICAL TREATMENT OF CORONARY ARTERY DISEASE WITH COMPLICATED POSTINFARCTION LEFT VENTRICULAR ANEURYSM

Abstract: Left ventricular aneurysms (LV aneurysms) are a common complication of acute myocardial infarction, in which the scar area of the left ventricular tissue gradually becomes thinner and dyskinetic. The aneurysm often consumes some of the left ventricular ejection, which ultimately leads to chronic heart failure, which may be refractory to drug therapy and require surgical repair with apical left ventricular aneurysm. Surgical techniques to restore the volume and shape of the left ventricle have evolved over the years. Surgical treatment of LV aneurysms was first performed by Charles Bailey [1]. Denton Cooley and colleagues [2] reported about the first resection in cardiopulmonary bypass. Over the next decades, in addition to traditional linear plastics, new methods of patch remodeling were developed and published in order to improve the results [3,6]. Although aneurysmectomy has been performed for almost five decades, the most appropriate surgical approach for a patient with LV dyskinetic aneurysm is still controversial. Myocardial ischemia leads to the loss of a part of the viable myocardium and causes a whole complex of morphological and functional disorders of the heart. The latter, as a rule, are based on the processes of cicatricial transformation of the left ventricular myocardium, leading to disproportionate stretching and thinning of its walls, dilatation and spherization of its cavity, which in turn is the cause of pathological changes in intraventricular spatial-geometric relationships, which together define the concept ischemic remodeling. The formation of a left ventricular aneurysm often occurs with acute occlusion of the LAD, which leads to the development of severe angina pectoris and a clinic of severe heart failure. Plasty of the left ventricular aneurysm according to Dor and modified by Academician L.A. Bokeria - circular narrowing of the orifice of the aneurysmal sac and endoventriculoplasty of the left ventricle with a synthetic patch, in postinfarction LV aneurysms, has proven its safety and effectiveness. This operation is devoid of the disadvantages inherent in other methods of left ventricular reconstruction. It allows for a complete resection of the aneurysm with minimal risk of critical reduction of the LV cavity. Reconstruction of the left ventricular aneurysm and myocardial revascularization leads to a significant improvement in pumping function and a decrease in symptoms of heart failure. As a clinical example, a case of successful surgical treatment of a giant left ventricular aneurysm is presented.

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