PubMed · 5234538
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T Pamukcoglu. 1967-11-01. Endocardial tuberculosis.. https://pubmed.ncbi.nlm.nih.gov/5234538/
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In 32 human embryos ranging from 4.0 to 42 mm CR-length, the volumes of the atrioventricular endocardial cushions and of the ventricular myocardium were estimated by the point counting method. The surface densities of the left and right ventricular apical trabeculations were estimated by the point and intersection counting method. It is concluded that the cushions do not grow after the 25 mm stage, by that time having reached the maximal value of 0.074 mm3. This supports the concept that the cushions do not materially contribute to the definitive atrioventricular valves. In young embryos, the left ventricular trabeculations are thicker (as concluded from their higher surface density) than the right ventricular trabeculations. Only around the 25 mm stage, the ratio becomes 1. After this stage, right ventricles have thicker trabeculations than left ventricles have. This supports the concept that the trabecular pattern is changed during the period of valve formation, which process is characterized by delamination of the inner myocardial layers.
The bias has been that the ideal anatomic circumstance for endocardial resection is the anterior left ventricular location. Posterior left ventricular aneurysms have been thought to be problematic to map and more difficult to close, and possibly to have a different substrate for ventricular tachycardia. To address this problem, we retrospectively reviewed the cases of 110 consecutive patients who underwent sequential endocardial resection for ventricular tachycardia between 1983 and 1991. Ninety-six patients had an anterior aneurysm, and 14 patients had a posterior aneurysm or infarct. Operative survival and 5-year survival were very similar between the two groups (p = not significant). A positive postoperative electrophysiological study was present in 11% of the anterior group versus 14% of the posterior group (p = not significant). There was a significantly greater incidence of mitral valve replacement in the posterior group, and we believe this was most likely due to frequent localization of the arrhythmia to the papillary muscle. Otherwise, patients with a posterior aneurysm or infarct had surgical results equivalent to those in patients with an anterior location. As long as there is a discrete aneurysm or infarct, endocardial resection is a safe and effective therapeutic procedure for ventricular tachycardia.
4 patients (P) with recurrent, sustained ventricular tachycardia (VT) resistant to medical treatment, underwent surgery for cure of this arrhythmia. Each P had episodes of VT lasting 30 or more seconds, 3 of them had episodes of ventricular fibrillation. In all cases rhythm disturbances were secondary to post myocardial infarction aneurysm. Coronary angiography showed in all P total occlusion of LAD, in 2 cases significant lesion in RCA were found. 1 P had lung cancer. All P underwent aneurysmectomy and an excision of the altered endocardium by Harken's method. The endocardial excision was performed without endocardial mapping. 2 P had concomitant CABG to RCA. In the P with lung cancer lobectomy was performed. There were 2 ++non-arrhythmic death. The P with lung cancer died because of sepsis due to lung abscess. One P died because of heart failure (preoperative EF 10%), 6 months after the surgery. The 2 survivors remained free of VT during a follow-up period 8 months. In conclusion, endocardial excision by Harken's method is efficient in treating recurrent sustained VT, resistant to medical treatment, in patients with post myocardial infarction aneurysm. The surgical procedure can be performed without intraoperative endocardial mapping.