Why is the surgical ventricular restoration operation effective for ischemic cardiomyopathy? Geometric analysis with magnetic resonance imaging of changes in regional ventricular function after surgical ventricular restoration
Journal
Journal of Thoracic and Cardiovascular Surgery
Journal Volume
137
Journal Issue
4
Pages
887-894
Date Issued
2009
Author(s)
Abstract
Objective: Clinical improvement after a surgical ventricular restoration for ischemic cardiomyopathy is increasingly accepted by clinicians, but the mechanism is not completely understood. Methods: Ten patients with ischemic cardiomyopathy underwent detailed magnetic resonance imaging for ventricular function before and 6 weeks after surgical ventricular restoration. Surgical procedures included combinations of coronary artery bypass grafting, restrictive mitral annuloplasty, and endoventricular patch plasty. Magnetic resonance imaging analysis included quantification of global and regional systolic function. Anterior and posterior left ventricular regions were divided by an imaginary plane (C-plane) determined from anterior mitral point and both papillary roots. Results: Global stroke volume index increased from 28.8 ± 4.9 mL/m2 to 36.5 ± 8.6 mL/m2 after surgical ventricular restoration (P = .010) and seemed more related to increased posterior stroke volume index (15.9 ± 4.3 mL/m2 preoperatively, 21.8 ± 3.9 mL/m2 postoperatively, P = .001) than to changed anterior stroke volume index (15.9 ± 4.4 mL/m2 preoperatively, 18.2 ± 6.9 mL/m2 postoperatively, P = .369). C-plane area decreased only a little in diastole (37.7 ± 8.3 cm2 preoperatively, 32.9 ± 5.9 cm2 postoperatively, P = .119) but significantly in systole (31.5 ± 9.4 cm2 preoperatively, 23.7 ± 7.6 cm2 postoperatively, P = .023). This indicates functional recovery of border zone by restrictive endoventricular patch plasty. Conclusion: Rebuilding geometric normality by surgical ventricular restoration improves contractility of myocardium in border-zone and remote regions, resulting in increased stroke volume index from the posterior left ventricle. ? 2009 The American Association for Thoracic Surgery.
Other Subjects
adult; aged; annuloplasty; article; clinical article; controlled study; coronary artery bypass graft; electrocardiogram; female; heart left ventricle ejection fraction; heart ventricle function; human; ischemic heart disease; male; nuclear magnetic resonance imaging; priority journal; stroke; surgical technique; transthoracic echocardiography; Aged; Cardiomyopathies; Female; Heart Ventricles; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Myocardial Contraction; Myocardial Ischemia; Postoperative Care; Preoperative Care; Stroke Volume; Treatment Outcome; Ventricular Function, Left
Type
journal article