key: cord-332503-3h4fovqx
authors: Hui, Dawn S.; Calhoon, John H.
title: On ventricular aneurysms, thrombi, and COVID-19
date: 2020-10-09
journal: Ann Thorac Surg
DOI: 10.1016/j.athoracsur.2020.09.006
sha: 
doc_id: 332503
cord_uid: 3h4fovqx

nan

We read with interest the letter by Dr. Babokin 1 and agree with his points regarding resection of peri-infarct myocardium that may harbor foci of ventricular tachycardia. The technique he describes is one of several to manage post-infarct left ventricular (LV) aneurysms, ranging from the simple linear technique to endoventricular circular patch plasty as we described. 2 Choice of technique should be patient-specific, with the salient points being restoration of normal LV volume and appearance as much as possible, exclusion of akinetic segments and nidus for thrombus, and preservation of mitral competency. When the LV cavity is opened, resection of the transition zone can be performed with visualization and surgical judgment. Dr. Babokin has published an innovative technique, 3 in which preoperative electroanatomic mapping is used to mark the transition zone with endocardial radiofrequency ablation lesions. Results were excellent in his series of 156 patients. While we have considered such a technique, we also consider that caution is warranted in cases with LV thrombus due to embolic risk.

As a note of contemporary relevance, we anticipate that the incidence of such cases may increase as a consequence of COVID-19. At our institution, we have seen a rise in post-infarct related complications such as ventricular septal defects, due to delay in seeking care. This anecdotal experience and concern are supported by studies worldwide, with the proportion of late presentations of ST-elevation myocardial infarctions increasing from 4.8% to 50%. 4 Further complicating this is the propensity of COVID-19 to incite thrombotic complications. Ventricular thrombi have been described as one manifestation, including biventricular thrombi complicating J o u r n a l P r e -p r o o f

The Annals of Thoracic Surgery Please cite this article as: Hui DS, Calhoon JH, On ventricular aneurysms, thrombi, and COVID-19

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