ABSTRACT
We encountered a case of Dor's operation for left ventricular aneurysm with cardiac failure 19 years after operation for post-infarction ventricular septal perforation. A 70-year-old man, who had undergone patch closure for ventricular septum perforation due to acute anteroseptal myocardial infarction, was admitted for congestive heart failure. Preoperative left ventriculography (LVG) revealed large anteroseptal and ventricular septal aneurysm. The left ventricular ejection fraction (LVEF) was 39%, and the left ventricular end diastolic volume (LVEDV) was 200ml. Dor's operation and coronary artery bypass grafting to the left circumflex branch was performed. The postoperative course was uneventful and the patient was discharged 33 days after the operation. Postoperative LVG revealed improved left ventricular function and showed that LVEF was 45% and LVEDV was 171ml. The large akinetic aneurysm was formed 19 years after operation following the linear closure method. LVG after Dor's operation showed remarkable improvement for left ventricular function. These findings indicated that Dor's operation is superior to the linear method.
ABSTRACT
Myonephropathic metabolic syndrome (MNMS) is a fatal complication following open-heart or aortic surgery. We evaluated 7 cases of MNMS following cardiac or aortic surgery. The patient's ages ranged from 43 to 81 years old. Of the 7 patients, four presented with myocardial infarction, which required coronary artery bypass grafting (CABG), and three presented with acute aortic dissection. Two patients with Stanford type A underwent total arch replacement and CABG and 1 patient with Stanford type B underwent a left axillo-femoral bypass. MNMS was caused by acute arterial occlusion due to intra-aortic balloon pumping (IABP) or percutaneous cardio-pulmonary support (PCPS) in patients who experienced myocardial infarction and acute lower limb ischemia in patients who experienced aortic dissection. The ratio of MNMS caused by IABP and PCPS, and acute aortic dissection was 1.4% and 4.2%, respectively. Four patients died; 3 had undergone CABG and 1 had undergone an aortic operation 18.5h after acute dissection. Both IABP and PCPS were removed early in possible cases. Limb wash-out was performed in 1 patient, and 5 were treated with hemodiafiltration. IABP and PCPS should be introduced via a prosthetic graft if limb ischemia is noticed. MNMS should be recognized as a disastrous complication of aortic dissection, and early bypass graft or limb amputation may become the treatment of choice. We emphasize that hemodiafiltration should begin as soon as MNMS is diagnosed.