Departments of Cardiovascular Surgery, Cardiology and Cardiovascular Anesthesia
Escorts Heart Institute and Research Centre, New Delhi

Background: Post-myocardial infarction, anteroseptal dysfunction or akinesia is treated by septal reshaping to improve the surgical outcome in patients with severe left ventricular dysfunction.

Methods and Results: Between February 2003 to December 2003, 30 consecutive patients with previous anterior wall myocardial infarction and severe ventricular dysfunction underwent septal reshaping. All the dyskinetic and akinetic septal areas were excluded using an oval dacron patch which was sutured from the healthy septal area to the anterior wall, resulting in formation of a new apex. There were two mortalities in the group. After a mean follow-up of 4.2±1.6 months (1-7 months) it was seen that this procedure resulted in significant reduction of ventricular volume, increase in ejection fraction, an improvement in New York Heart Association class from 2.9±1.1 to 1.7±0.3, and a better apical geometry.

Conclusions: In selected patients with left anterior descending artery occlusion resulting in anteroseptal dyskinesia or akinesia, septal exclusion technique provides good clinical and morphological results with significant improvement in left ventricular function. (Indian Heart J 2005; 57: 44–48)

Key Words: Coronary artery bypass surgery, Ventricular dysfunction, Septal reshaping