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Congenital cardiac anomalies
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
The Dor procedure involves resection of a left ventricular aneurysm with patch closure of the ventriculotomy. It is performed primarily in adults following transmural myocardial infarctions of the left ventricular free wall, resulting in aneurysmal dilatation.
Surgical treatment of subacute heart failure and a surprising diagnosis
Published in Acta Cardiologica, 2021
Hicham El Jattari, Jef Verheyen, Filip Haenen, Inez E Rodrigus, Bernard P Paelinck
A 66-year-old patient was transferred because of progressive dyspnoea NYHA III. Symptoms started 6 months earlier following a laparoscopic robot-assisted prostatectomy. At admission the patient was cachectic and in poor condition with clinical features of left and right heart failure including hypotension, bibasilar crackles and peripheral oedema. ECG displayed pathologic Q-waves in the left precordial and lateral leads. Chest radiography showed cardiomegaly and bilateral pleural effusion. Troponin I was slightly elevated (0.287 μg/L, normal value <0.045 μg/L). Transthoracic echocardiogram showed a huge apical aneurysm containing a massive thrombus (arrow, Figure 1A) and a dilated left ventricle (LV) with severe dysfunction (LV ejection fraction 15%) together with moderate functional mitral and tricuspid insufficiency. Initial patient management consisted of diuretics, titration of ACE-inhibitors and beta blocking agents. Coronary angiography showed an occluded mid-left anterior descending artery (LAD) with limited collateral circulation originating from the right coronary artery (RCA). LV angiogram raised suspicion of a concealed perforation of the LV apex with inlaying thrombus (arrow, Figure 1B). Cardiac magnetic resonance imaging confirmed the large, thin-walled pseudoaneurysm in the proximal LAD-territory with absence of the myocardial lining in the apex but containing a large intracavitary thrombus (arrow, Figure 1C), suggesting a concealed myocardial rupture or LV pseudoaneurysm of the apical wall (Supplementary data online, Video 1). A thrombectomy (arrow, Figure 1D) and aneurysmectomy of the LV apical wall (Dor procedure) with mitral and tricuspid valve repair was performed. Patient was discharged to a revalidation centre in good general condition 3 months after Dor procedure.