Dataset Information

A new surgical ventricular restoration technique to reset residual myocardium's fiber orientation: the "KISS" procedure.

ABSTRACT: BACKGROUND: The history of surgical reconstruction of the left ventricle after an anterior myocardial infarction shows an evolution of techniques which tend to a more and more physiologic restoration of ventricular shape and volume, with increasing attention to the orientation of myocardial fibers. METHODS: We set a new surgical procedure for endoventricular patch reconstruction technique with the aim to rebuild a physiologic shape and volume of the left ventricle caring about realignment of myocardial fibers orientation. Peculiarities of this reconstruction are the shape of the patch (reduction of minor axis compared with currently used oval-shaped patch) and the asymmetrical way of suturing it inside the ventricle. RESULTS: We present a detailed description of operative steps of this procedure, and we add some relevant surgical hints to clarify its peculiarities. Most of the patients operated on with this technique showed the original renewal of apical rotation and left ventricular torsion as specific index of the restoration of physiologic fiber orientation: we report an exemplary case of at-sight recovery of apical rotation in the operating room. CONCLUSION: This technique can represent a reproducible new way to realign myocardial fibers in a near-normal setting, improving the physiological restoration of ischemically injured left ventricle. It could be also the basis to reconsider surgical treatment for heart failure.

SUBMITTER: Cirillo M

PROVIDER: S-EPMC2718891 | biostudies-other | 2009

REPOSITORIES: biostudies-other

ACCESS DATA

Publications

A new surgical ventricular restoration technique to reset residual myocardium's fiber orientation: the "KISS" procedure.

Cirillo Marco M

Annals of surgical innovation and research 20090623

<h4>Background</h4>The history of surgical reconstruction of the left ventricle after an anterior myocardial infarction shows an evolution of techniques which tend to a more and more physiologic restoration of ventricular shape and volume, with increasing attention to the orientation of myocardial fibers.<h4>Methods</h4>We set a new surgical procedure for endoventricular patch reconstruction technique with the aim to rebuild a physiologic shape and volume of the left ventricle caring about reali ...[more]

PMID: 19549296

Similar Datasets

Project description:ObjectivesSeveral issues that are inherent in the surgical techniques of surgical ventricular restoration (SVR) need specialized devices or techniques to overcome them, which may not always result in optimal outcomes. We used a non-invasive novel in silico modelling technique to study left ventricular (LV) morphology and function before and after SVR. The cardiac magnetic resonance imaging derived actual pre- and postoperative endocardial morphology and function was compared with the in silico analysis of the same.MethodsCardiac magnetic resonance steady state free precession (SSFP) cine images were employed to segment endocardial surface contours over the cardiac cycle. Using the principle of Hausdorff distance to examine phase-to-phase regional endocardial displacement, dyskinetic/akinetic areas were identified at the instant of peak basal contraction velocity. Using a three-dimensional (3D) surface clipping tool, the maximally scarred, dyskinetic or akinetic LV antero-apical areas were virtually resected and a new apex was created. A virtual rectangular patch was created upon the clipped surface LV model by 3D Delaunay triangulation. Presurgical endocardial mechanical function quantified from cine cardiac magnetic resonance, using a technique of spherical harmonics (SPHARM) surface parameterization, was applied onto the virtually clipped and patched LV surface model. Finally, the in silico model of post-SVR LV shape was analysed for quantification of regional left ventricular volumes (RLVVs) and function. This was tested in 2 patients with post-myocardial infarction antero-apical LV aneuryms. Left ventricular mechanical dysynchrony was evaluated by RLVV analysis of pre-SVR, in silico post-SVR and actual post-SVR LV endocardial surface data.ResultsFollowing exclusion of the scarred areas, the virtual resected LV model demonstrated significantly lesser areas of akinesia. The decreases in regional LV volumes in the in silico modelling were significant and comparable with the actual decreases following SVR. Both the regional end diastolic volume (EDV) and end systolic volume (ESV) at the apex decreased significantly corresponding to greater reductions in apical volumes by the technique of rectangular patch plasty (apical EDV 2.1607 ± 0.20577 to 0.4774 ± 0.1775 ml, P = 0.007; apical ESV 1.9708 ± 0.36451 to 0.442 ± 0.047 ml, P = 0.013).ConclusionsThis pilot study was done using novel in silico techniques for virtual surgical modelling, which helped in accurate estimation and planning of optimal LV restoration by SVR.

Dataset Information

A new surgical ventricular restoration technique to reset residual myocardium's fiber orientation: the "KISS" procedure.

Publications

A new surgical ventricular restoration technique to reset residual myocardium's fiber orientation: the "KISS" procedure.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets