V.B. Simonenko, I.A. Borisov, A.N. Bletkin, E.V. Gaidukova, M.I. Uimanova, T.V. Dieva, D.D. Savichev Surgery for left ventricular aneurysm complicated with thrombotic endocarditis

Prognosis of heart failure development in patients with the history of acute myocardial infarction (AMI) depends on changes of left ventricular (LV) volume and geometrical form. Involvement of epicardial and subepicardial layers results in significant distortion of architectonics of ventricular walls, сonsequently impairs the coordinated process of contraction of myocardial fibers. The changes of their length and ratio on the background of decreased conductivity contribute to development of asynergic contraction. Normal ellipsoid ventricular form is transformed into spheroid cavity where fiber contraction vector becomes more transversally directed. Involvement of the interventricular septum and posterior wall into process significantly accelerates geometrical changes and decreases contractile ability of entire myocardium to critical level. Alterations in the geometrical intracavitary proportions also impairs transformation of myocardial tension to pressure and leads to transforming of normal spiral blood flow into turbulent one, predisposing to LV thrombus formation. It is well known that the incidence of LV thrombosis is high in patients with AMI and left ventricular aneurysm (LVA). Mural thrombi present in about half of all LVAs. The main complication of the thrombosis process is embolization. Thrombotic endocarditis occurs more rarely in patients with LVA. Bacteraemia and thrombotic endocarditis may also lead to myocardial abscesses, intracardiac fistulae and even generalized sepsis development. We present the experience of surgical treatment of LVA complicated with thrombotic endocarditis.

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