Excision of Akinetic Left Ventricular Wall for Intractable Heart Failure

Abstract

Left ventricular akinesis (localized lack of wall motion) may have a profound effect on cardiac hemodynamics. The diagnosis is established by cineangiography. Three patients with angiographically proved coronary atherosclerosis and intractable congestive failure underwent resection of akinetic ventricular wall during temporary cardiopulmonary bypass. In two patients (Cases 2 and 3) thin fibrotic scars were resected; in one patient (Case 1) a full thickness area of diseased muscle was removed. All patients survived the operation and had improvement of symptoms. Cardiac catheterization in one patient (Case 1) documented improved left ventricular function 9 months after surgery. Although the two other patients (Cases 2 and 3) had improvement in symptoms, they died 7 and 16 weeks after surgery. The rationale of subjection of seriously ill patients to extensive cardiac surgery is based on the idea that an area of noncontractile left ventricular wall can be identified by angiography and may be excised with improvement in left ventricular function.