Restoring an elliptical chamber during rebuilding a wrap around anterior infarction.

Left ventricular geometry is distorted after anterior infarction caused by occlusion of a wrap around left anterior descending artery. Loss of the apex creates a spherical left ventricular (LV) chamber, whose rebuilding requires reconstruction techniques that exclude the non-functional inferior wall. The described technique of tailoring the apex defines a way to create an oblique elliptical rim for subsequent patch placement to complete the restoration procedure. This method of ventricular rebuilding differs from methods that follow the inferior wall scar, which result in a restoration procedure that leaves a spherical or box-like apical region.     

Bidimensional echocardiographic diagnosis of the pulmonary valve agenesis syndrome in the newborn infant. Description of 2 cases

We describe the cases of two neonates affected by the syndrome of pulmonary valve agenesis, in whom non-invasive diagnosis was possible by two dimensional echocardiography. The echocardiographic features we describe are the following: enlargement of the right ventricle in association with ventricular septal defect, malalignment type, dilatation of the right ventricular outflow tract, massive dilation of the main and branch pulmonary arteries, annular pulmonary stenosis. At the expected site of the pulmonary valve two ridges were seen, which did not have the typical motion of a fully developed valve. The ventricular septal motion was paradoxical in both cases. The diagnosis was confirmed at cardiac catheterization and the two neonates underwent operation unsuccessfully. The anatomic post-mortem examination confirmed the echocardiographic and angiographic findings. As successful treatment of this syndrome is difficult, we believe that a non-invasive echocardiographic diagnosis is very useful in order to avoid or, at least, delay a high risk cardiac catheterization.     

Surgical therapy of ventricular arrhythmias

Since the advent of implantable cardioverters/defibrillators (ICD) and percutaneous ablation, surgery for the treatment of ventricular arrhythmia has decreased tremendously. Nevertheless, surgical treatment of ventricular arrhythmias is still required, especially for cases where ICD discharge occurs very frequently or in patients with other indications for surgery. The choice of surgical therapy may range from radiofrequency- or cryoablation of a single focus (identified either intra- operatively or percutaneously) to more extensive surgical procedures such as surgical ventricular reconstruction with endocardial resection or even resection of the right ventricle and the creation of a cavo-pulmonary circulation for malignant arrhythmias and right ventricular failure in patients with arrhythmogenic right ventricular dysplasia. However, the choice of surgical procedure should be made based on the pathomechanism of the arrhythmia. This is important because any incision in the left or right ventricle or percutaneous ablation may also be the cause for ventricular arrhythmia. In this short review we will describe the most common underlying substrates for ventricular arrhythmia, indications for surgery, the techniques used for treatment and the results achieved. We will conclude that for most cases of patients with ventricular arrhythmia undergoing surgery, ischemia and the presence of a scar after myocardial infarction is the underlying cause and revascularization plus surgical ventricular reconstruction with endocardial resection may be the best treatment option.