ABSTRACT
Left ventricular overlapping operation was applied to a woman with cardiac sarcoidosis who presented with cardiopulmonary arrest. She did not have any particular history, with minimal risk factors for atherosclerosis. By-stander cardiopulmonary resuscitation delivered by her husband saved her life. Acute coronary syndrome was denied by emergency coronary arteriography. However, left vetriculography revealed broad dyskinetic area inconsistent with coronary distribution. Those findings raised a high suspicion of cardiac sarcoidosis, although this was unconfirmed. Broad ventricular aneurysm and a history of cardiac arrest and congestive heart failure prompted us to operate on her. Left ventricular overlapping operation was applied followed by ICD implantation and steroid induction. The pathologic examination of the ventricular wall showed noncaseous epithelioid granulomas and polynuclear giant cells, which are consistent with cardiac sarcoidosis. She has been leading a healthy daily life without signs of heart failure for one and a half years after discharge. Lesions of cardiac sarcoidosis have a broad spectrum from narrow localized to wide generalized aneurysm. Appropriate surgical strategy should be performed according to the location and the extent of the lesion. Left ventricular overlapping operation is among the alternatives.
ABSTRACT
For patients with advanced heart failure, surgical left ventricular restoration (SVR) is an option usually evaluated by nuclear cardiac imaging, magnetic resonance imaging and ultrasonography. The clinical application of multi detector-row computed tomography (MDCT) has been increasingly extended to evaluate not only coronary artery stenosis, but also cardiac function, myocardial perfusion and viability. We report a successful surgical case of ischemic cardiomyopathy evaluated by MDCT in pre- and post-LVR. A 59-year old man was admitted to our hospital because of worsening heart failure. He had a history of coronary artery bypass grafting after myocardial infarction of the anterior wall at age 45 but had discontinued his medication 5 years previously. Ultrasonography showed poor left ventricular function, massive mitral regurgitation and a floating mural thrombus which required emergency surgery. In addition to conventional coronary angiography, electrographically-gated MDCT clearly described the complex coronary anatomy and stenosis, global and regional left ventricular function, and the relation between the mural thrombus and the scarred myocardium. Thrombectomy, LVR (overlapping type), coronary artery bypass grafting and mitral annuloplasty were performed. Postoperative MDCT showed improvement in left ventricular volume and function in the time-volume analysis, in wall thickness and wall thickening in both the SVR site and remote sites in four-dimensional volumetric imaing. Our case suggests that MDCT can be a valuable tool for the cardiac surgeon.