Dor Procedure Repair of a Huge Left Ventricular Aneurysm: A Case Report

Materials and Methods 

A 56-year-old male with a history of systemic hypertension presented with dyspnea on exertion, classified as New York Heart Association (NYHA) Class III for one month. C 
linical examination revealed an apex beat located at the fifth left interspace outside the midclavicular line, along with slightly reduced air entry in the left hemithorax. 

The 2D echocardiogram indicated ischemic heart disease (IHD), positive regional wall motion abnormalities (RWMA+), SEC+, and a 2.7x 2.25 cm mass observed in the left ventricular (LV) apex, with an ejection fraction (EF) of 30 percent, moderate LV dysfunction, accompanied by an a 
kinetic septum. A CT scan of the thorax revealed a huge anterolateral LV aneurysm with a large thrombus inside.  

The patient was optimized and planned for the Dor procedure. 

Intraoperative Findings 

Intraoperative findings included the LV aneurysm repair (the Dor’s procedure), which was presented in this video. The patient made an uneventful recovery and was doing well at the 120-day follow-up visit, with a left ventricular ejection fraction (LVEF) of 40 percent and no clots and trivial mitral regurgitation (MR) and tricuspid regurgitation (TR). The patient was maintained on antiplatelet therapy, rosuvastatin, carvedilol, and torsemide, with normal hepatic and renal functions.  

In this patient, the Dor procedure was decided upon due to the very large size of the aneurysm. Coronary artery bypass grafting (CABG) was deferred due to the involvement of the distal thin left anterior descending (LAD) artery into the scarred area and the diffusely diseased diagonal branch (D1), which was also involved in the sac. 

Laplace's law explains the mechanism by which patients with an aneurysmal LV benefit from ventricular reconstruction. Reducing the radius of the LV cavity decreases stress on the LV wall, providing three benefits: it reduces oxygen consumption at the cardiac level, increases myocardial efficiency enabling the heart to perform the same amount of work with lower energy expenditure, and improves myocyte orientation, thereby enhancing contractile efficiency (1). 

References

1. Di Donato M, Sabatier M, Toso A, Barletta G, Baroni M, Dor V, Fantini F.. Regional myocardial performance of non-ischaemic zones remote from anterior wall left ventricular aneurysm. Effects of aneurysmectomy. Eur Heart J 1995; 16 9: 1285– 92.

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