Consequently, the intraventricular guideposts for reconstruction that usually involves patch. When a patient is diagnosed with a ventricular aneurysm, cardiac surgeons open the chest, remove the weakened area of the ventricle wall, and sew the walls of the ventricle back together. In small aneurysms not involving the septum, the theoretical advantages of evpp are less convincing. Left ventricular aneurysm resection and remodeling dor procedure. In each case, the svr procedure was performed by means of endoventricular circular patch plasty as previously described by dor and associates. Patients with a large akinetic scar and severely depressed pump function benefit from a relatively simple surgical procedure previously reserved only for. The aim of the study was to compare these 2 methods with regard to early mortality and longterm survival. Surgical ventricular restoration is an option in patients with. It involves use of a radiopharmaceutical, injected into a patient, and a gamm. Detailed assessment of the lv wall motion to help guide optimal lv resection and.
In 1984, dor used endoventricular circular patch plasty the dor procedure to restore lv. You have had a scan of your leg arteries to assess the blood flowing through them. Hypertrophied muscle is cut along the whole length until the mucosa bulges out. Adoption, customization and innovation 60th annual meeting of iacts, kovalam, trivandrum, 20th23rd. Both morphology and hemodynamic of left ventricle, are improved. Endoventricular patch plasty by dr janardhana reddy d chennai, india. Radionuclide angiography is an area of nuclear medicine which specialises in imaging to show the functionality of the right and left ventricles of the heart, thus allowing informed diagnostic intervention in heart failure.
The outcomes of the applied ventricular aneurysm repair technique were. Certain patients who present following a transmural anterior wall myocardial infarct with an akinetic or dyskinetic wall segment, have been shown to benefit from endoventricular circular patch plasty as described by dor. A 17year experience vincent dor marisa di donato michel saba tier franfoise montiglio filippo civaia and the restore group the first experience with endoventricular circular patch plasty evcpp was reported in 1984 as a surgical method to rebuild left ventricular lv geometry made more. Left ventricular reconstruction by endoventricular circular patch plasty repair. Early results after surgical treatment of left ventricular. This has confirmed that one or more of the main arteries that carries blood to your leg is blocked in the region of your groin, meaning that the blood flow to the leg is reduced. Application of circular patch plasty dor procedure or linear repair. Dor procedure or the endoventricular circular patch plasty evccp, is an operation, introduced by vincent dor, in 1985. Ventricular energetics in endoventricular circular patch plasty. Radionuclide angiography wikimili, the free encyclopedia. In 1985, dor introduced evcpp as a viable method for restoring a dilated left ventricle lv to its normal, elliptical geometry. Mccarthy, cleveland clinic, has described a double pursestring suture technique.
Linear repair dominated early in the series and patch plasty dominated later, giving a. Unlike linear repair, left ventricular volume changes seem stable. Endoventricular patch plasty was introduced as a more physiologic repair than the linear closure technique, especially when the aneurysm extends into the septum. The endoventricular circular patch plasty dor procedure applies to patients with. Mizuno et al 17 reported biventricular pacing in a case of cabg with endoventricular circular patch plasty, with a good result. Left ventricular reconstruction by endoventricular. Aneurysm repair is often followed by medication therapy. Dor procedure for dyskinetic anteroapical myocardial. Surgical outcome of endoventricular circular patch plasty repair for postinfarction myocardial scar relates to the extent of lv asynergy rather than to the presence or absence of dyskinesia. Ventricular energetics in endoventricular circular patch plasty for. For surgical repair of lv aneurysm, the e ndoventricular circular patch plasty.
Dor operation endoventricular circular patch plasty youtube. Also, iino et al 18 reported biventricular pacing 18 month after partial left ventriculectomy and mitral valve repair, for recurrent symptoms of heart failure, with a. Simple linear resection and endoventricular patch plasty are alternative techniques to repair postinfarction left ventricular aneurysm. Devices, systems and methods supplement, repair, or replace a native heart valve. Endoventricular patch plasty dor is used to reduce left ventricular volume after myocardial infarction and subsequent left ventricular remodeling.
Surgical ventricular restoration has been performed for many years, and a number of different surgical techniques and modifications have been developed to restore left ventricular lv shape and to improve lv function. Improved healthrelated quality of life and functional status. A 17year experience vincent dar, marisa di donato, michel sabatier, franfoise montiglio, filippo civaia, and the restore group the first experience with endoventricular circular patch plasty evcpp was reported in 1984 as a surgical method to rebuild left ventricular lv geometry made more spheric after. Endoventricular patch plasty dor is used to reduce left ventricular. Surgical ventricular restoration bluecross blueshield of. The endoventricular circular patch plasty dor procedure. The devices, systems, and methods employ an implant that, in use, extends adjacent a valve annulus. Left ventricular reconstruction was performed with endoventricular circular patch plasty evcpp dor procedure or linear repair technique. Name of blue advantage policy surgical ventricular restoration. Left ventricular aneurysm lva is a serious complication of myocardial infarction and reduces the chances of survival. Left ventricular aneurysm ina 4yearold boy texas heart institute journal surgery for left ventricular aneurysm. Surgical management of left ventricular aneurysms by the endoventricular circular patch plasty technique vincent dor in 1958, cooley resected a left ventricular aneurysm lva while using cardiopulmonary bypass to sustain the systemic circulation, thereby ushering in the mod ern era of surgery for left ventricular aneurysms.
Controversy still exists regarding the optimal surgical technique for lva repair. From 1984 to 2000, 950 left ventricular ischemic asynergy dyskinetic or akinetic were operated using the endoventricular circular patch plasty technique. Iliac and femoral endarterectomy and patch plasty why do i need an operation. Left ventricular volume and function after endoventricular patch. Specific modifications include the doubleopposing zplasty sometimes called a jumping man flap which can be useful for release of webbing of the medial canthus or release of 1st web space contractures. Risk factors for mortality and hospital readmission after. A search of computerized databases supplemented with manual. This allows to exclude all asynergic areas of the left ventricular wall and reshape the remaining wall.
Impact of surgical ventricular restoration on ventricular. Marisa di donato, michel sabatier, vincent dor, anna toso, mauro maioli and fabio fantini, akinetic versus dyskinetic postinfarction scar. Surgical repair of a postinfarct ventricular septal rupture vsr remains a difficult surgical challenge associated with a significant operative mortality. Patients who had leaky mitral heart valves repaired along with bypass surgery had with healthier hearts than those who had bypass only, according to new research presented in the american heart. Surgical ventricular restoration svr has been shown to improve hemodynamics and survival among patients with coronary artery disease, left ventricular aneurysm, and heart failure. Endoventricular patch plasty for dyskinetic anteroapical left ventricular aneurysm increases systolic circumferential shortening in sheep.
The implant includes a mobile neoleaflet element that occupies the space of at least a portion of one native valve leaflet. Modified endoventricular circular plasty dor procedure. Relation to surgical outcome in patients undergoing endoventricular circular patch plasty repair, journal of the american college of cardiology, 29, 7, 1569, 1997. Dor pioneered expansion of techniques for ventricular reconstruction and is credited with treating congestive heart failure. Also, iino et al 18 reported biventricular pacing 18 month after partial left ventriculectomy and mitral valve repair, for recurrent symptoms of heart failure, with a favorable evolution.
The endoventricular patch plasty, as originally described by dor, always includes the use of a patch. The dor procedure is a medical technique used as part of heart surgery and originally introduced by the french cardiac surgeon vincent dor b. The aim of this study was to investigate functional status and healthrelated quality of life after svr. Manual backward elimination of variables was performed on the basis of the. Us patent for devices, systems, and methods for supplementing. Endoventricular circular patch plasty dor operation ctsnet. Endoventricular patch plasty dor procedure has gained favor as a surgical treatment for heart failure associated with large anteroapical myocardial infarction. Simple linear resection and endoventricular patch plasty are alternative. Jul 24, 2017 endoventricular patch plasty by dr janardhana reddy d chennai, india.
The repair involves endoventricular circular patch plasty and application of gelatinresorcinolformaldehyde biological glue in the space between a teflon felt patch on the infarcted septum and a bovine pericardial patch in the left ventricular cavity. Surgical ventricular restoration, remodeling, heart failure. Modified endoventricular circular plasty dor procedure ctsnet. Long term follow up of left ventricular function after repair of left ventricular aneurysm. We analyze the efficacy of two techniques, linear vs. Atrial septal defect surgical repair inpatient care what. Risk factors for mortality and hospital readmission after surgical. Modified endoventricular circular plasty dor procedure tuesday, july 22, 2008.
Lv reconstruction with endoventricular circular suturing and patching. The device consists of an oval tissue patch made from glutaraldehydefixed bovine pericardium. Improved left ventricular aneurysm repair with bioengineered. The procedure itself is a viable method of restoring a dilated left ventricle to its normal eliptical geometry. Coronary artery stenosis and anatomy were evaluated using coronary angiography and a coronary luminal stenosis. Relation to surgical outcome in patients undergoing endoventricular circular patch plasty repair.
Early and late survival after simple linear repair and endoventricular patch plasty abstractj thorac cardiovasc surg. It is also known as endoventricular circular patch plasty evcpp. Jan 25, 2016 dor operation endoventricular circular patch plasty. In some of these patients, there had been concomitant mitral regurgitation that required mitral valve repair surgery mvs by means of restrictive mitral annuloplasty. Left ventricular reconstruction by endoventricular circular. Postinfarction ventricular septal perforation repair with. This video demonstrates two cases of left ventricular circular patch plasty dor operation for large. Ventricular aneurysm repair cardiac surgery boston. Food and drug administration fda through the 510k process that is specifically labeled for use as an intracardiac patch for cardiac reconstruction and repair.
Relation to surgical outcome in patients undergoing endoventricular circular patch plasty repair, journal of the american college of cardiology, 29, 7. Moreover, patch aneurysmorrhaphy is not associated with lv redilation. We tested the hypotheses that the dor procedure increases systolic circumferential shortening. Endoventricular patch plasty can improve lv function. A pyloromyotomy is a surgical procedure in which an incision is made in the longitudinal and circular muscles of the pylorus. Dor operation endoventricular circular patch plasty. Mitral valve repair with bypass surgery may improve heart. Mribased finiteelement analysis of left ventricular. Nov 21, 2012 left ventricular aneurysm lva is a serious complication of myocardial infarction and reduces the chances of survival. Timisoara medical journal giant left ventricular aneurysm. We present here a case of endstage nonischemic valvular dilated cardiomyopathy dcm associated with mitral regurgitation mr.
Doublepatch repair of postinfarction ventricular septal defect. Dor pioneered expansion of techniques for ventricular reconstruction and is credited with treating congestive heart failure patients with svr in conjunction with cabg. Dor operation endoventricular circular patch plasty video. Dor procedure for dyskinetic anteroapical myocardial infarction fails. Surgical ventricular restoration svr is a procedure designed to restore or remodel the left ventricle to its normal, spherical shape and size in individuals with akinetic segments of the heart, secondary to ischemic dilated cardiomyopathy.
B luecross blueshield of tennessee medical policy manual. The correstore patch system is a device approved by the u. Care guide for atrial septal defect surgical repair inpatient care. We introduce a new operative procedure of infarct exclusion with polytetrafluroethylene ptfe patch and closure of ventriculotomy without pledged or felt. Offpump anteroapical aneurysm plication following left.
The endoventricular circular patch plasty dor procedure in ischemic akinetic dilated ventricles. If left untreated, ventricular aneurysm can lead to heart failure or dangerous blood clotting. The patient underwent surgery where left ventricular volume reduction using endoventricular circular patch plasty evcpp and mitral valve replacement mvr were performed. This is the pitfall of using the scar as the guide in grossly dilated ventricles. Endoventricular circular patch plasty dor operation. Animals used in this study were treated in compliance with the guide for the care. A 17year experience vincent dor marisa di donato michel saba tier franfoise montiglio filippo civaia and the restore group the first experience with endoventricular circular patch plasty evcpp was reported in 1984 as a. When adjusted for multiconfounders, the risk of early mortality was significantly higher after simple linear repair than after endoventricular patch plasty odds ratio, 4. Endoventricular circular patch plasty for endstage. The geometric reconstruction of the left ventricle with intraventricular patch dors operation is also performed in ischemic. There were 8 men and 2 women with age range of 47 to 71 years. Application of circular patch plasty dor procedure or.
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