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Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
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Table of Contents
VIDEO COMMENTARY  
Year : 2015  |  Volume : 18  |  Issue : 3  |  Page : 392
Video Commentary 1: Tee for endoventricular patch plasty/dor procedure


Department of Cardiac Anaesthesia, CNC, AIIMS - New Delhi, India

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Date of Web Publication1-Jul-2015
 

How to cite this article:
Singh SP, Narula J, Malhotra P. Video Commentary 1: Tee for endoventricular patch plasty/dor procedure. Ann Card Anaesth 2015;18:392

How to cite this URL:
Singh SP, Narula J, Malhotra P. Video Commentary 1: Tee for endoventricular patch plasty/dor procedure. Ann Card Anaesth [serial online] 2015 [cited 2019 Nov 17];18:392. Available from: http://www.annals.in/text.asp?2015/18/3/392/159820


·Myocardial infarction (MI) induced ischemic cardiomyopathy leading to LV aneurysm is the most common cause of heart failure accounting for up to 70% of the cases. ([Figure 1]A)
Figure 1:

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  • Loss of regional contraction
  • Alters cardiac structure/function relationship
·Geometric consequence: Loss of function of LV free wall and septum ([Figure 1]B)

·Surgical therapy for symptomatic large left ventricular aneurysms includes exclusion of nonfunctional segments of ventricular wall and restoration of more normal ventricular geometry. [Figure 2]A&B)
Figure 2:

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·Implantation of a patch

  • Endoventricular patch plasty or Dor procedure and restores normal LV shape.


·Direct/linear closure

  • First reported by Cooley


·TEE Views

  • ME 4chamber short axis view
  • ME LV long Axis view
  • Transgastric mid papillary short axis view
  • Transgastric mid papillary short axis view with CFD
  • Transgastric LV long axis view


·DOR Procedure: ([Figure 3]A)
Figure 3:

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  • Considered as the gold standard in surgery for left ventricular aneurysms, because of improved preservation of ventricular geometry
  • Mitral repair and surgery for ventricular septal defect are performed as needed along with LV aneurysm repair
  • Placement of an endoventricular patch through left ventriculotomy from an incision parallel to the LAD to exclude the scarred/fibrotic tissue ([Figure 3]B)


·Role of TEE:([Figure 4]A&B)
Figure 4:

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  • Clarifying cardiac anatomy
  • Identification of septal defects, ischemic dilated cardiomyopathy, pericardial effusion/ tamponade
  • Infarction induced changes in ventricular shape and volume, regional wall motion abnormalities
  • Estimation of LV volumes and ejection fraction
  • Assessment of ischaemic mitral regurgitation


·TEE Doppler:

·Doppler gradients across MV for adequacy of MV repair showing peak gradient of 7 mm Hg and 4 mm Hg across the mitral valve and E/A ratio of 1.1. ([Figure 5] A&B)
Figure 5:

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·Transgastric short axis view of the left ventricle (LV) and basal ubferolateral true aneurysm dimensions preop and post repair

·Midesophageal 4 chamber view post DOR Procedure showing the endoventricular patch ([Figure 6]A)
Figure 6:

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·Midesophageal commissural view showing the endoventricular patch ([Figure 6B])




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Correspondence Address:
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.159820

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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