Early surgical anteroseptal ventricular endocardial restoration after acute myocardial infarction. Pathophysiology and surgical considerations.
BACKGROUND
The efficacy and safety of surgical anteroseptal ventricular endocardial restoration (a procedure that excludes non-contracting scarred segments) in the left ventricle with chronic dilation and remodeling secondary to an anterior myocardial infarction are well established. We present a small series and discuss the indication for early left ventricular restoration in the setting of complicated acute myocardial infarction.


METHODS
Early ventricular restoration was performed in 8 patients (4 males, 4 females, mean age 70 +/- 8 years). A postinfarction ventricular septal defect was diagnosed in 3 cases. All patients were operated, on an urgent or emergent basis, between 1 and 16 days following the onset of infarction. Surgical coronary revascularization was associated in 7 patients.


RESULTS
There was one operative death. At discharge, echocardiographic morphofunctional assessment revealed: a reduction of the left ventricular end-diastolic and end-systolic volume indexes, an increase of the ejection fraction, and, most importantly, an improvement of remote myocardial shortening fraction. At a mean follow-up of 15.6 months (range 2-21 months), there were no late deaths and all survivors are in NYHA functional class I or II.


CONCLUSIONS
Left ventricular restoration may represent an effective adjunct to the surgical management of patients with an acute extensive anterior myocardial infarction complicated by severe heart failure, with or without septal rupture.
Fundarò
Pino
P
Division and Chair of Cardiac Surgery, University of Milan, IRCCS Ospedale Maggiore, Milan, Italy. pinofundaro@yahoo.it
Pocar
Marco
M
Marchetto
Giovanni
G
Moneta
Andrea
A
Mattioli
Roberto
R
Donatelli
Francesco
F
Grossi
Adalberto
A
D000368:Aged; D001026:Coronary Artery Bypass; D004108:Dilatation, Pathologic; D005260:Female; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D009203:Myocardial Infarction / Q000150:complications*; D013526:Surgical Mesh; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*