Heart failure following anterior myocardial infarction: an indication for ventricular restoration, a surgical method to reverse post-infarction remodeling.
Anterior myocardial infarction produces abrupt left ventricular (LV) dysynergy and global systolic dysfunction. Rapid intense neurohumoral activation, infarct expansion, and early ventricular chamber dilatation all contribute to restoring a normal stroke volume despite a persistently depressed ejection fraction. Continued neurohumoral activation provokes late remodeling of the remote non-infarcted myocardium, characterized by an abnormal progressively increasing LV volume/mass ratio that leads to further LV remodeling. Heart failure is a progressive disorder of LV remodeling. Heart failure from post-infarction remodeling is unique because of the persistent non-functioning scar that self- perpetuates abnormal loading conditions and neurohumoral activation. Medical therapy attenuates remodeling and improves survival but does not change the size of the scar. Surgical ventricular restoration to exclude the non-functioning infarct from the ventricular cavity decreases ventricular volumes, increases global ejection fraction, attenuates neurohumoral activation and yields an excellent 5-year survival. Combined medical and surgical therapy is recommended in this patient population.
Stanley
Alfred W H
AW
Kemp-Carraway Heart Institute and Center for Heart Failure Management, Carraway Methodist Medical Center, Birmingham, Alabama, USA.
Athanasuleas
Constantine L
CL
Buckberg
Gerald D
GD
D004699:Endocardium / Q000503:physiopathology / Q000601:surgery; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications*; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D020257:Ventricular Remodeling / Q000502:physiology*