Dor Procedure for Extended Postinfarction Left Ventricular Aneurysm with Secondary Pseudoaneurysm

A sixty-six-year-old man underwent investigation for a recent onset of shortness of breath and was found to have a chronically occluded LAD, a severely dilated left ventricle, reduced ejection fraction, and a large anterior aneurysm. There had been a contained rupture at some stage, and a large false aneurysm had developed. Dor repair (endoventricular circular repair with patch) was indicated. The operation was conducted through a median sternotomy, and a cardiopulmonary bypass was established with aorto-bicaval cannulation and an arrested heart. Both the false and true aneurysm walls were resected, and two purse strings were placed in the healthy tissue of the left ventricular defect, aiming to reduce its size. The insertion of a homemade ventricular sizer helped to assess the amount of necessary tension to be applied while tying the purse strings. Following this, a double-layered patch of equine pericardium was sutured to the defect, and the remnant of the aneurysm wall was closed over the patch in a linear fashion with a Teflon-buttressed suture.

The patient was extubated the next morning, weaned off inotropes on postoperative day two, and had an uneventful hospital stay. The predischarge echocardiogram showed a telediastolic left ventricular volume of 120mls. 

Reference

1. Left Ventricular Reconstruction for Postinfarction Left Ventricular Aneurysm: Review of Surgical Techniques. Andrea Ruzza, Lawrence S.C. Czer, Francisco Arabia, Roberta Vespignani, Fardad Esmailian, Wen Cheng, Michele A. De Robertis, Alfredo Trento. Tex Heart Inst J. 2017 Oct; 44(5): 326-335.

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