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A case of double-chambered left ventricle presenting with heart failure symptoms.

Cardiol Young

July 2023

University of California San Diego Adult Congenital Heart Center, Division of Cardiovascular Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA.

Double-chambered left ventricle is a rare CHD that is usually asymptomatic and managed conservatively but can present with ventricular arrhythmias or heart failure. It is important to differentiate from acquired diseases such as post-infarct pseudoaneurysm that need surgical treatment, and cardiac MRI offers an excellent diagnostic tool.

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Disease-induced repolarization heterogeneity in infarcted myocardium contributes to VT arrhythmogenesis but how apicobasal and transmural (AB-TM) repolarization gradients additionally affect post-infarct VT dynamics is unknown. The goal of this study is to assess how AB-TM repolarization gradients impact post-infarct VT dynamics using patient-specific heart models. 3D late gadolinium-enhanced cardiac magnetic resonance images were acquired from seven post-infarct patients.

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Aims: Our study assesses the value of electrograms (EGMs) characteristics to identify a ventricular tachycardia (VT) isthmus entrance in patients with post-infarct VT. Post-infarct VTs are mostly due to a re-entrant circuit. A pacemapping (PM) approach is able to localize the VT isthmus during sinus rhythm.

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Article Synopsis
  • The study aims to create an efficient processing pipeline that transforms CT images into personalized cardiac electrophysiology models for better planning of radiofrequency ablation in ventricular tachycardia.
  • A patient-specific 3D heart model is built from CT scans, incorporating scar identification and wave propagation simulation to assist in real-time virtual pacing and target prediction for ablation.
  • The framework shows promise in improving outcomes of VT interventions by potentially reducing procedure time and enhancing success rates through accurate pre-operative planning.
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Article Synopsis
  • The study focuses on the surgical treatment of left ventricular pseudoaneurysm (LVP), a rare condition with high mortality rates, analyzing 13 patients over a 10-year span.
  • Various surgical techniques were employed, including suturing and patching, alongside other procedures like coronary artery bypass, with an operative mortality rate of 30.8%.
  • The study concludes that surgical repair of post-infarct LVP can have an acceptable mortality rate and notes that no cardiac ruptures occurred in the treated patients.
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