Case report
New less invasive ventricular reconstruction technique in the treatment of ischemic heart failure
Nova técnica menos invasiva de reconstrução ventricular no tratamento de insuficiência cardíaca isquémica
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(A2) cardiac computed tomography (CT) scan before the procedure to assess the possibility of percutaneous treatment; (B1) intraoperative transesophageal echocardiogram showing normalization of ventricular shape and reduction of LV volume; (B2) cardiac CT scan post-procedure showing the anchor pairs and absence of contrast leakage between the excluded scar and the LV.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rita Faria, Bruno Melica, Gustavo Pires-Morais, Alberto Rodrigues, José Ribeiro, Miguel Guerra, Vasco Gama, Luís Vouga" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Rita" "apellidos" => "Faria" ] 1 => array:2 [ "nombre" => "Bruno" "apellidos" => "Melica" ] 2 => array:2 [ "nombre" => "Gustavo" "apellidos" => "Pires-Morais" ] 3 => array:2 [ "nombre" => "Alberto" "apellidos" => "Rodrigues" ] 4 => array:2 [ "nombre" => "José" "apellidos" => "Ribeiro" ] 5 => array:2 [ "nombre" => "Miguel" "apellidos" => "Guerra" ] 6 => array:2 [ "nombre" => "Vasco" "apellidos" => "Gama" ] 7 => array:2 [ "nombre" => "Luís" "apellidos" => "Vouga" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S087025511400153X" "doi" => "10.1016/j.repc.2014.02.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511400153X?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914001780?idApp=UINPBA00004E" "url" => "/21742049/0000003300000078/v2_201411090043/S2174204914001780/v2_201411090043/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0870255114001036" "issn" => "08702551" "doi" => "10.1016/j.repc.2014.03.002" "estado" => "S300" "fechaPublicacion" => "2014-07-01" "aid" => "463" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2014;33:471.e1-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7337 "formatos" => array:3 [ "EPUB" => 185 "HTML" => 6203 "PDF" => 949 ] ] "pt" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Quando parece estenose valvular mitral mas não é – implicações diagnósticas e terapêuticas" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "471.e1" "paginaFinal" => "471.e6" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "When what appears to be mitral stenosis is not: Diagnostic and therapeutic implications" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1563 "Ancho" => 2916 "Tamanyo" => 325999 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Ecocardiograma transesofágico (plano 121°): morfologia da válvula mitral em diástole (à esquerda) e em sístole (à direita); observam‐se os folhetos posterior (seta A) e anterior (seta B) com boa abertura e destaca‐se a presença de uma estrutura ecogénica a nível da face auricular do anel mitral (seta verde).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Inês Almeida, Francisca Caetano, Joana Trigo, Paula Mota, Maria do Carmo Cachulo, Manuel Antunes, António Leitão Marques" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Inês" "apellidos" => "Almeida" ] 1 => array:2 [ "nombre" => "Francisca" "apellidos" => "Caetano" ] 2 => array:2 [ "nombre" => "Joana" "apellidos" => "Trigo" ] 3 => array:2 [ "nombre" => "Paula" "apellidos" => "Mota" ] 4 => array:2 [ "nombre" => "Maria do Carmo" "apellidos" => "Cachulo" ] 5 => array:2 [ "nombre" => "Manuel" "apellidos" => "Antunes" ] 6 => array:2 [ "nombre" => "António" "apellidos" => "Leitão Marques" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204914001688" "doi" => "10.1016/j.repce.2014.03.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914001688?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114001036?idApp=UINPBA00004E" "url" => "/08702551/0000003300000078/v4_201411060056/S0870255114001036/v4_201411060056/pt/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0870255114001462" "issn" => "08702551" "doi" => "10.1016/j.repc.2014.01.017" "estado" => "S300" "fechaPublicacion" => "2014-07-01" "aid" => "479" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2014;33:467.e1-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 11770 "formatos" => array:3 [ "EPUB" => 200 "HTML" => 10437 "PDF" => 1133 ] ] "pt" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso Clínico</span>" "titulo" => "Hematoma intramural da aorta: evolução (im)previsível?" 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Observam‐se as duas endopróteses aórticas parcialmente sobrepostas, recobrindo o IMH e o canal arterial, desde a artéria subclávia esquerda até ao início da aorta abdominal, sem evidência de <span class="elsevierStyleItalic">endoleaks</span> (A). Na figura C, a imagem de DAo distalmente à prótese (seta), com origem ao nível do tronco celíaco e estendendo‐se até à artéria mesentérica superior. Comparativamente à angioTC pós‐procedimento, na angioTC de controlo aos seis meses observa‐se uma regressão quase total do IMH (D e E) e o desaparecimento da imagem de DAo abdominal (F).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta Ponte, Nuno Dias Ferreira, Nuno Bettencourt, Daniel Caeiro, Marlene Fonseca, Aníbal Albuquerque, Luís Vouga, Vasco Gama" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Marta" "apellidos" => "Ponte" ] 1 => array:2 [ "nombre" => "Nuno" "apellidos" => "Dias Ferreira" ] 2 => array:2 [ "nombre" => "Nuno" "apellidos" => "Bettencourt" ] 3 => array:2 [ "nombre" => "Daniel" "apellidos" => "Caeiro" ] 4 => array:2 [ "nombre" => "Marlene" "apellidos" => "Fonseca" ] 5 => array:2 [ "nombre" => "Aníbal" "apellidos" => "Albuquerque" ] 6 => array:2 [ "nombre" => "Luís" "apellidos" => "Vouga" ] 7 => array:2 [ "nombre" => "Vasco" "apellidos" => "Gama" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => 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Faria, Bruno Melica, Gustavo Pires-Morais, Alberto Rodrigues, José Ribeiro, Miguel Guerra, Vasco Gama, Luís Vouga" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Rita" "apellidos" => "Faria" "email" => array:1 [ 0 => "rita.d.faria@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Bruno" "apellidos" => "Melica" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Gustavo" "apellidos" => "Pires-Morais" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Alberto" "apellidos" => "Rodrigues" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "José" "apellidos" => "Ribeiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Miguel" "apellidos" => "Guerra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Vasco" "apellidos" => "Gama" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Luís" "apellidos" => "Vouga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Nova técnica menos invasiva de reconstrução ventricular no tratamento de insuficiência cardíaca isquémica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1321 "Ancho" => 1400 "Tamanyo" => 244596 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">(A) Preoperative long-axis (2-chamber) cine cardiac magnetic resonance (CMR) obtained at end-diastole (A1) and end-systole (A2). Note the severe LV dilatation with a large anterior/apical aneurysm. The apex and distal segments of all walls had thin walls and were dyskinetic in cine studies; (A3) late gadolinium enhancement (LGE) CMR revealing transmural scar (>75%) in the distal segments of all walls and apex, and subendocardial scar in the mid segments of the anteroseptal and anterior walls. Apical thrombus was detected (necessitating oral anticoagulation before surgery); (B) six-month follow-up cine CMR at end-diastole (B1) and end-systole (B2) showing significant reduction in LV volumes. In cine studies the apex exhibits dyskinesia; (B3) in LGE CMR, the apex and mid and distal segments of the anterior and anteroseptal walls presented transmural scar. Note the signal void caused by the metal anchors (titanium).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Surgical ventricular reconstruction (SVR) has become a surgical option for patients with severe ischemic heart failure. SVR effectively reduces LV volume and wall tension and is known to improve neurohormonal status.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> However, its impact on mortality, functional capacity and quality of life is still controversial.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Recently, a new technique, Less Invasive Ventricular Enhancement (LIVE), has been developed using the Revivent™ Myocardial Anchoring System (Bioventrix Inc., San Ramon, CA). In this technique, plication and exclusion of the aneurysm is achieved using anchors which are implanted into the scarred portion of the heart, rendering the LV smaller. Conceptually, the final configuration in SVR can be achieved by placing these implants. However, Revivent™ achieves this outcome without an LV incision and thus without the need for cardiopulmonary bypass (CPB).</p><p id="par0015" class="elsevierStylePara elsevierViewall">The system consists of four components: a catheter-based delivery system, a force gauge to control the anchors when apposing the LV walls, the implantable anchor elements, and a retrieval system (to remove the implants if necessary). The implantable components consist of polyester fabric-covered titanium anchor pairs: one hinged internal anchor that passes through a low-profile catheter to the right side of the septum and one locking external anchor deployed in an LV epicardial position (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A and B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">We report the case of a 41-year-old Caucasian male evaluated in our center for severe ischemic cardiomyopathy. The patient had suffered a transmural anterior myocardial infarction six months earlier for which he sought no medical help, and was in NYHA class II despite optimal heart failure therapy for at least 90 days (160 days). His past history included smoking, hypertension, dyslipidemia and type II diabetes. He was evaluated after this event for post-infarction angina. Catheterization showed occlusion of the proximal left anterior descending coronary artery without additional lesions.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Transthoracic echocardiography (TTE) depicted a severely dilated LV with a large anteroapical aneurysm and severe LV dysfunction (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A1), which was also seen on the cardiac computed tomography scan (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A2). Mild mitral regurgitation was present. Due to the absence of tricuspid regurgitation, pulmonary artery systolic pressure could not be estimated.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Cardiovascular magnetic resonance (CMR) confirmed these findings, with LV end-systolic volume index (LVESVI) of 223 ml/m<span class="elsevierStyleSup">2</span>, LV end-diastolic volume index (LVEDVI) of 264 ml/m<span class="elsevierStyleSup">2</span> and ejection fraction (EF) of 0.15 (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A1 and A2). The apex and distal segments of all myocardial walls presented transmural (>75%) late gadolinium enhancement, indicating absence of myocardial viability (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A3). Apical thrombus was detected.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The patient provided informed consent and was enrolled in the CONFIGURE-HF trial (phase II), a multicenter, prospective, single-armed study designed to establish the efficacy and safety of the new LIVE system for left ventricular volume reduction in patients with heart failure due to large anteroseptal scars. Major inclusion criteria are: (a) EF <0.35; (b) LVESVI >60 ml/m<span class="elsevierStyleSup">2</span> (preferably <120 ml/m<span class="elsevierStyleSup">2</span>); (c) symptomatic heart failure (NYHA class II-IV) despite optimal medical therapy for at least 90 days; (d) age 18–75 years; (e) no infarction within three months of operation; (f) referral for ventricular reduction operation. Major exclusion criteria are: (a) need for concomitant mitral valve surgery; (b) the presence of intracardiac thrombus; (c) contraindication for warfarin therapy in the three months after surgery.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In our patient, the presence of apical thrombus required four months of anticoagulation and repeated imaging showing resolution of the thrombus, for inclusion. His LVESVI >120 ml/m<span class="elsevierStyleSup">2</span> was not an impediment, since the basal segments and other LV segments had preserved contractility.</p><p id="par0045" class="elsevierStylePara elsevierViewall">After sternotomy, extensive scarring of the anterior LV wall was evident on inspection. A total of seven anchor pairs were implanted under direct fluoroscopic and transesophageal echocardiography (TEE) guidance (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The considerable size of the aneurysm rendered this case unique, as only one anchor was passed through the LV septum, and the others were placed entirely in an epicardial position. Also of note, an above-average number of anchors were necessary to achieve the final result.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The procedure lasted 209 minutes (skin to skin). No complications occurred. TEE at the end of the procedure showed normalization of ventricular shape, significant reduction of LV volumes (>50%) and slightly improved EF (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B1). The patient was discharged home on the 7th day post-procedure. On discharge, no leakage between the excluded scar and the LV was observed (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B2).</p><p id="par0060" class="elsevierStylePara elsevierViewall">At the one-month follow-up visit, the patient was in NYHA class I and had resumed normal daily activities. Functional capacity assessed by the six-minute walk test improved significantly at six months (138 m improvement compared to baseline).</p><p id="par0065" class="elsevierStylePara elsevierViewall">CMR at six months demonstrated significant LV volume reduction (LVESVI: 87 ml/m<span class="elsevierStyleSup">2</span>, LVEDVI: 143 ml/m<span class="elsevierStyleSup">2</span>) and improvement in EF (39%) (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>B1 and B2).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">SVR has been demonstrated to be beneficial in selected patients.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6–8</span></a> However, there is substantial debate over the superiority of SVR with coronary artery bypass grafting (CABG) compared to CABG alone.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Recently, results from a post-hoc analysis of the Surgical Treatment for Ischemic Heart Failure (STICH) randomized trial demonstrated that there are subgroups of patients who can benefit from SVR.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> For example, a postoperative LVESVI of 70 ml/m<span class="elsevierStyleSup">2</span> or less after CABG plus SVR resulted in enhanced survival compared with CABG alone. Also, an analysis by Dor et al., in a patient cohort excluded from the STICH trial, demonstrated favorable results of SVR, indicating that is not possible to extrapolate the results of STICH to all this population.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In high-risk patients, the apparently improved risk profile of the LIVE technique may be an advantage compared to other SVR procedures, as it does not require LV incision or CPB and is a potentially more rapid procedure. Furthermore, it has potential advantages regarding standard linear resection, as the septum is included in the repair. Early results of this technique were recently published and documented an effective volume reduction at one-year follow-up.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">As highlighted in this case report, in the LIVE technique the walls of the ventricle stay perfectly aligned and with no residual communication between the LV and the excluded cavity, reducing the risk of clots, a concern in this type of ‘closed’ procedure.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Even so, patients are empirically anticoagulated for three months after the procedure.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In our patient the large size of the aneurysm and severely compromised LV systolic function did not preclude a favorable outcome. This could be explained by the preserved contractility of other LV segments and the relatively early treatment. Nevertheless, some concern was raised regarding long-term remodeling, with the six-month follow-up CMR showing incomplete exclusion of the septal scar and a dyskinetic apex (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>B3).</p><p id="par0090" class="elsevierStylePara elsevierViewall">The results of the CONFIGURE-HF trial and long follow-up data are required to determine the long-term safety and effectiveness of the technique.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of human and animal subjects</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres380832" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec359645" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres380833" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec359644" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Right to privacy and informed consent" ] ] ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 9 => array:2 [ "identificador" => "xack100833" "titulo" => "Acknowledgments" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-10-19" "fechaAceptado" => "2014-02-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec359645" "palabras" => array:4 [ 0 => "Ischemic cardiomyopathy" 1 => "Heart failure" 2 => "Surgical ventricular reconstruction" 3 => "Off-pump surgery" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec359644" "palabras" => array:4 [ 0 => "Cardiomiopatia isquémica" 1 => "Insuficiência cardíaca" 2 => "Reconstrução ventricular esquerda" 3 => "Cirurgia sem circulação extracorporal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ischemic cardiomyopathy is the leading cause of heart failure. In patients with left ventricular (LV) dilatation, low ejection fraction, and transmural scar in an anteroseptal distribution, surgical ventricular reconstruction (SVR) is a treatment option.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We describe our first experience with the Less Invasive Ventricular Enhancement (LIVE) technique using the Revivent™ system (Bioventrix Inc., San Ramon, CA), in the treatment of a large anteroapical aneurysm.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A cardiomiopatia isquémica é a principal causa de insuficiência cardíaca. A cirurgia de reconstrução ventricular é uma opção terapêutica em doentes com dilatação e disfunção sistólica do ventrículo esquerdo e cicatriz de enfarte transmural da parede anterior e septo.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Os autores pretendem descrever a sua experiência inicial com uma técnica menos invasiva de reconstrução ventricular (<span class="elsevierStyleItalic">Less Invasive Ventricular Enhancement</span> [LIVE]) utilizando o sistema Revivent™ (Bioventrix Inc., San Ramon, CA, EUA), no tratamento de um volumoso aneurisma ântero-apical.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2724 "Ancho" => 2500 "Tamanyo" => 1029935 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A and B) LIVE technique, consisting of plication of the LV scar through a series of epicardially delivered anchor pairs that pull the LV free wall to the septum; (C) intraoperative image of plication of the large anteroapical aneurysm.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1362 "Ancho" => 1700 "Tamanyo" => 360425 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">(A1) Baseline transthoracic echocardiogram in 4-chamber view showing the large LV aneurysm and preserved basal segments; (A2) cardiac computed tomography (CT) scan before the procedure to assess the possibility of percutaneous treatment; (B1) intraoperative transesophageal echocardiogram showing normalization of ventricular shape and reduction of LV volume; (B2) cardiac CT scan post-procedure showing the anchor pairs and absence of contrast leakage between the excluded scar and the LV.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1321 "Ancho" => 1400 "Tamanyo" => 244596 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">(A) Preoperative long-axis (2-chamber) cine cardiac magnetic resonance (CMR) obtained at end-diastole (A1) and end-systole (A2). Note the severe LV dilatation with a large anterior/apical aneurysm. The apex and distal segments of all walls had thin walls and were dyskinetic in cine studies; (A3) late gadolinium enhancement (LGE) CMR revealing transmural scar (>75%) in the distal segments of all walls and apex, and subendocardial scar in the mid segments of the anteroseptal and anterior walls. Apical thrombus was detected (necessitating oral anticoagulation before surgery); (B) six-month follow-up cine CMR at end-diastole (B1) and end-systole (B2) showing significant reduction in LV volumes. In cine studies the apex exhibits dyskinesia; (B3) in LGE CMR, the apex and mid and distal segments of the anterior and anteroseptal walls presented transmural scar. Note the signal void caused by the metal anchors (titanium).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular reconstruction: the aim and reality after twenty years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "V. Dor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtcvs.2004.02.026" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2004" "volumen" => "128" "paginaInicial" => "17" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15224016" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilatation" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "the RESTORE group" "etal" => true "autores" => array:3 [ 0 => "C.L. Athanasuleas" 1 => "G.D. Buckberg" 2 => "W.H. Stanley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2004.07.017" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2004" "volumen" => "44" "paginaInicial" => "1439" "paginaFinal" => "1445" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15464325" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurohormonal response to left ventricular reconstruction surgery in ischemic cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Schenk" 1 => "P.M. McCarthy" 2 => "R.C. Starling" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtcvs.2003.11.012" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2004" "volumen" => "128" "paginaInicial" => "38" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15224019" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronary bypass surgery with or without surgical ventricular restoration" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "for the STICH Hypothesis 2 Investigators" "etal" => true "autores" => array:3 [ 0 => "R.H. Jones" 1 => "E.J. Velazquez" 2 => "R.E. Michler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0900559" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2009" "volumen" => "360" "paginaInicial" => "1705" "paginaFinal" => "1717" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19329820" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Durability of epicardial ventricular restoration without ventriculotomy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.S. Wechsler" 1 => "J. Sadowski" 2 => "B. Kapelak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ejcts/ezt292" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2013" "volumen" => "44" "paginaInicial" => "e189" "paginaFinal" => "e192" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23739293" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical therapy for ischemic heart failure: single-center experience with surgical anterior ventricular restoration" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Menicanti" 1 => "S. Castelvecchio" 2 => "M. Ranucci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtcvs.2006.12.027" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2007" "volumen" => "134" "paginaInicial" => "433" "paginaFinal" => "441" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17662785" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of left ventricular reconstruction on survival in patients with ischemic cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.O. O’Neill" 1 => "R.C. Starling" 2 => "P.M. McCarthy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejcts.2006.07.018" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2006" "volumen" => "30" "paginaInicial" => "753" "paginaFinal" => "759" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17023172" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes following surgical ventricular restoration for patients with clinically advanced congestive heart failure (New York Heart Association class IV)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.A. Williams" 1 => "E.S. Weiss" 2 => "N.D. Patel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Cardiac Fail" "fecha" => "2007" "volumen" => "13" "paginaInicial" => "431" "paginaFinal" => "436" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insights from the STICH trial: change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "for the STICH Trial Investigators" "etal" => true "autores" => array:3 [ 0 => "R.E. Michler" 1 => "J.L. Rouleau" 2 => "H.R. Al-Khalidi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtcvs.2012.09.007" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2013" "volumen" => "146" "paginaInicial" => "1139" "paginaFinal" => "1145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23111018" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Favorable effects of left ventricular reconstruction in patients excluded from the Surgical Treatments for Ischemic Heart Failure (STICH) trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V. Dor" 1 => "F. Civaia" 2 => "C. Alexandrescu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2011" "volumen" => "142" "paginaInicial" => "905" "paginaFinal" => "916" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack100833" "titulo" => "Acknowledgments" "texto" => "<p id="par0115" class="elsevierStylePara elsevierViewall">We would like to express our gratitude to Dr. Nuno Bettencourt and Dr. Nuno Ferreira of the Cardiovascular Imaging Department and to Dr. Rodolfo Pereira of the Department of Cardiothoracic Surgery.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003300000078/v4_201411060056/S087025511400153X/v4_201411060056/en/main.assets" "Apartado" => array:4 [ "identificador" => "29263" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Casos Clínicos" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003300000078/v4_201411060056/S087025511400153X/v4_201411060056/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511400153X?idApp=UINPBA00004E" ]
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| 2017 Fevereiro | 45 | 5 | 50 |
| 2017 Janeiro | 21 | 4 | 25 |
| 2016 Dezembro | 28 | 4 | 32 |
| 2016 Novembro | 28 | 5 | 33 |
| 2016 Outubro | 41 | 19 | 60 |
| 2016 Setembro | 112 | 3 | 115 |
| 2016 Agosto | 46 | 8 | 54 |
| 2016 Julho | 14 | 6 | 20 |
| 2016 Junho | 2 | 0 | 2 |
| 2016 Maio | 28 | 6 | 34 |
| 2016 Abril | 43 | 8 | 51 |
| 2016 Maro | 56 | 14 | 70 |
| 2016 Fevereiro | 71 | 20 | 91 |
| 2016 Janeiro | 46 | 16 | 62 |
| 2015 Dezembro | 58 | 11 | 69 |
| 2015 Novembro | 48 | 14 | 62 |
| 2015 Outubro | 47 | 11 | 58 |
| 2015 Setembro | 49 | 22 | 71 |
| 2015 Agosto | 64 | 12 | 76 |
| 2015 Julho | 61 | 8 | 69 |
| 2015 Junho | 37 | 8 | 45 |
| 2015 Maio | 54 | 5 | 59 |
| 2015 Abril | 79 | 16 | 95 |
| 2015 Maro | 43 | 13 | 56 |
| 2015 Fevereiro | 37 | 13 | 50 |
| 2015 Janeiro | 52 | 11 | 63 |
| 2014 Dezembro | 37 | 16 | 53 |
| 2014 Novembro | 55 | 21 | 76 |
| 2014 Outubro | 62 | 31 | 93 |
| 2014 Setembro | 92 | 52 | 144 |
Mostrar tudo
