Reconstructive left ventricular surgery for post-ischemic akinetic dilatation.

The term dyskinesia refers to a post-ischemic fibrous area of ventricle that moves in a paradoxical manner during ventricular systole and diastole, ie, an aneurysm. Akinesia indicates that such an area of scarred ventricle exhibits no movement during either systole or diastole. In the past, it has been considered extremely important, from a surgical standpoint, to differentiate between dyskinesia, which can be treated surgically, and akinesia, which cannot be treated by surgery. Because the only alternative form of surgical therapy in many of these patients is cardiac transplantation, we have applied the technique of reconstruction of akinetic areas by our endocardial ventricular patch plasty technique in the same manner as that used for areas of dyskinesia. The surgical results, especially in patients with large areas of akinesia in the left ventricle, confirm the validity of this direct approach to the treatment of a frequently complex problem.