Video Commentary 2: "Tee for direct closure for LV aneurysm repair"

• INTRODUCTION: • Surgical ventricular restoration (SVR) by direct closure of LV aneurysm is simed at restoring LV geometry as much as possible as shown in Figure – 1A&B • TEE Views For direct closure: • Transgastric mid papillary short axis view showing pseudoaneurysm of LV free wall measuring 1.57 cm x 2.33 cm along with hemorrhagic pericardial effusion measuring 1.96 cm along with clots in the pericardial cavity. (Figure – 2A&B) • Mid esophageal long axis view showing collapse of right atrium and right ventricle in diastole due to massive effusion. (Figure – 3A&B) • Transgastric mid papillary short axis view with color flow doppler showing LV free wall pseudoaneurysm with flow across it into the pericardium (Figure – 4A) • Transgastric LV long axis view showing the pericardial fluids around the LV cavity and the apical pseudoaneurysm dimension (Figure – 4B) • Hepatic Venous Doppler profile showing diastolic flow reversal secondary to cardiac tamponade with a S/D ration of 1.6 (Figure – 5A) • POST REPAIR: • Post bypass trans-gastric mid-papillary short axis view showing intact LV (Figure – 5B) • Transgastric short axis view of the left ventricle (LV) and basal inferolateral true aneurysm dimensions preop and post repair showing decreased length (Fig6A&B) Fig -1A Fig -1B