Improvement of Left Ventricular Function after Modified Surgical Ventricular Restoration: Good, Better, Best

Authors

  • Marco Cirillo
  • Emmanuel Villa
  • Giovanni Troise

DOI:

https://doi.org/10.1532/HSF98.20081037

Abstract

Background: The techniques of surgical reconstruction of the left ventricle after an anterior myocardial infarction have evolved toward an increasingly physiologic restoration of ventricular shape and volume, with increasing attention being paid to the multilayered structure of myocardial fibers.

Methods: We describe the case of a patient who underwent operation with a new technique of endoventricular patch restoration surgery, which was aimed at rebuilding the physiologic shape and volume of the left ventricle, with special care taken to realign the orientation of myocardial fibers at the site of the surgical suture on the patch. The case was studied preoperatively and postoperatively via a complete echocardiographic assessment, included 2-dimensional speckle tracking imaging for the study of apical rotation and ventricular torsion.

Results: All geometric and functional parameters were improved at the early and late postoperative evaluations. The left ventricular shape, diameters, and volumes were restored to near-normal values. Apical rotation was improved, both immediately after the surgical procedure and at the late followup, with the normal systolic counterclockwise movement and the small clockwise rotation during isovolumic contraction having been restored—signs of normal fiber disposition. As a consequence, torsion of the ventricle was restored, given that the basal rotation remained the same as before the operation.

Conclusions: The beneficial restoration of apical rotation and left ventricular torsion is indirect evidence that our new technique can effectively realign myocardial fibers in a near-normal setting and thereby optimize all aspects of left ventricular performance.

References

Cirillo M, Arpesella G. 2008. Rewind the heart: a novel technique to reset heart fibers' orientation in surgery for ischemic cardiomyopathy. Med Hypotheses70:848-54.nHelle-Valle T, Crosby J, Edvardsen T, et al. 2005. New noninvasive method for assessment of left ventricular rotation: speckle tracking echocardiography. Circulation112:3149-56.nLutgens E, Daemen MJAP, de Muinck ED, Debets J, Leenders P, Smits JFM. 1999. Chronic myocardial infarction in the mouse: cardiac structural and functional changes. Cardiovasc Res41:586-93.nSetser RM, Kasper JM, Lieber ML, Starling RC, McCarthy PM, White RD. 2003. Persistent abnormal left ventricular systolic torsion in dilated cardiomyopathy after partial left ventriculectomy. J Thorac Cardiovasc Surg 126:48-55.nSetser RM, Smedira NG, Lieber ML, Sabo ED, White RD. 2007. Left ventricular torsional mechanics after left ventricular reconstruction surgery for ischemic cardiomyopathy. J Thorac Cardiovasc Surg134:888-96.nSpotnitz HM. 2000. Macro design, structure, and mechanics of the left ventricle. J Thorac Cardiovasc Surg119:1053-77.nTakeuchi M, Nishikage T, Nakai H, Kokumai M, Otani S, Lang RM. 2007. The assessment of left ventricular twist in anterior wall myocardial infarction using two-dimensional speckle tracking imaging. J Am Soc Echocardiogr20:36-44.nTorrent-Guasp F, Kocica MJ, Corno AF, et al. 2005. Towards new understanding of the heart structure and function. Eur J Cardiothorac Surg27:191-201.nWalker JC, Guccione JM, Jiang Y, et al. 2005. Helical myofiber orientation after myocardial infarction and left ventricular surgical restoration in sheep. J Thorac Cardiovasc Surg129:382-90.n

Published

2008-10-22

How to Cite

Cirillo, M., Villa, E., & Troise, G. (2008). Improvement of Left Ventricular Function after Modified Surgical Ventricular Restoration: Good, Better, Best. The Heart Surgery Forum, 11(5), E266-E269. https://doi.org/10.1532/HSF98.20081037

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Article