LV-LV
LV-LV scar exclusion can be applied when there is LV scar limited to the
antero-lateral and apical walls, without septal involvement.
Consequently, the reconstruction doesn’t include the septum in the
exclusion. As such, the procedure is carried out in a purely surgical
fashion.
Case planning follows the same principles of multimodality imaging.
Anchor deployment and orientation can be tailored to the scar location
and full scar exclusion should be feasible in most patients
(Figure 6B ). The patients treated with this therapy have
suffered from a LAD MI and the consequent scar tissue is located in
anterior, antero-septal, antero-lateral and apical segments. However,
different scar locations can be addressed with this technique as it is
essentially based on plicating scarred segments, using the same surgical
approach. In fact, manipulation of the heart from an apical skin
incision by the liberal use of “myocardial leashes” - temporary “U”
stitches in the scarred myocardium, snugged and fixed with a hemostatic
clamp, enabling direct manipulation of the heart without hemodynamic
disturbance - allows the surgeon to expose the lateral and inferior
walls as well. Figure 6C shows an example of a post-operative
left ventriculography of patient with an extensive lateral scar due to a
previous left circumflex myocardial infarction.