FIGURES
Fig. 1 –Linear excision of an anterolateral aneurysm. A, the aneurysm
is incised and its surface is almost completely excised. B, the defect
is sutured over 2 teflon stripes. In presence of a scarred and
dyskinetic septum (C), a patch was sewn over the septum (D) to reduce
the septal surface and to eliminate the systolic bulging (E).
Fig. 2 – In presence of a septoapical aneurysm (A), a pericardial patch
is sewn on the borders of the healthy septum on three sides. The
anterior portion of the patch is pulled tight and incorporated in the
modified linear closure as indicated by the arrows (B). The patch
excludes the aneurysmal portion of the septum and helps to maintain a
conical shape (C).
Fig. 3 – A, the aneurysm is incised and almost completely excised. The
lateral wall of the left ventricle is sutured down in the septum at the
border of the scar with interrupted sutures that are brought out at the
right ventricle. B, a second line of suture is necessary to connect the
scar close to the LAD to the healthy myocardium.
Fig. 4 – Simplification of the Stoney technique. Linear septoexclusion.
A, the border between the scarred and the healthy portion of the
anterior wall is sutured with the border between the scarred and healthy
septum till the apex. Part of the apical scar, if necessary, is included
in the remaining LV cavity to obtain a longitudinal axis as long as
possible. Septal reshaping (B-D). B, stitches are passed at 4 positions
in the septum: at the highest point where the anterior and septal scars
meet (1); at the level of the new apex (2); deep in the septum at the
border between the scar and the healthy posterior septum (3); and in the
anterior wall, again at the limit of the scar (4). C, a dacron or bovine
patch is tailored and fixed with the 4 stitches previously placed. D, a
new ventricular chamber is created, that has a shape as conical as
possible. Apical scars are often included.
Fig. 5 – The Jatene technique. A, the septal dyskinesia is treated by
means of e few U stitches, passed in both directions. A purse string
follows the border of the scar, but includes the septum inside the new
cavity. B, Once the purse string is tied, the opening can be closed
directly of by a patch (C).
Fig. 6 – The Dor technique as originally described. In presence of an
anteroseptal aneurysm (A), the scar is excised as well as the septal
endocardial scar. A patch, of the same size of the defect, is trimmed
(B) and sutured to close the defect (C).
Fig. 7 – Menicanti’s modification of the Dor technique. A, to obtain a
conical shape, a shaper is inserted inside the LV. B, if the inferior
region is severely dilated, it is plicated, placing the apex in a more
anterior position. A circular suture (Fontan stitch) to exclude the
affected anterior and septal tissue starts from this new apex, and the
plane of suture is more oblique with a resultant elliptical shape. C,
the shaper is out from the ventricle and the defect is closed with a
patch.