title: A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle.
abstract: BACKGROUND
  Long-term morphofunctional outcome may vary widely in surgical anterior left ventricular wall restoration, suggesting variability in post-surgical remodeling similar to that observed following acute myocardial infarction. The aim of this pilot study was to demonstrate that surgical restoration obtained with a particular shape of endoventricular patch leads to steady morphofunctional ventricular improvement when geometry, volume and residual akinesia can be restored as normal as possible.
  
  
  METHODS
  This study involved 12 consecutive patients with previous anterior myocardial infarction, dilated cardiomyopathy and no mitral procedures, who underwent left ventricular reconstruction and coronary revascularization between May 2002 and May 2003 using a small, narrow, oval patch aiming at a volume <or= 45 mL/m2 with elliptical shape. Eleven geometric parameters were examined preoperatively and at least 3, 12 and 24 months after the operation by serial echocardiographic studies and evaluated by paired t test taking the time of surgery as a starting point for remodeling.
  
  
  RESULTS
  All patients were in NYHA class 1 at follow-up. Patch geometry obtained a conical shape of the ventricle with new apex, physiologic rearrangement of functioning myocardial wall and small residual akinesia. Ventricular changes at the four time-points showed that all parameters improved significantly compared to preoperative values (end-diastolic volume = 184.2 +/- 23.9 vs 139.9 +/- 22.0, p = 0.001; vs 151.0 +/- 33.8, p = 0.06; vs 144.9 +/- 34.0, p = 0.38; end-systolic volume = 125.7 +/- 20.6 vs 75.2 +/- 14.1, p = 0.001; vs 82.1 +/- 23.9, p = 0,18; vs 77.1 +/- 19.4, p = 0.41) without further changes during follow-up except for wall motion score index (2.0 +/- 0.2 to 1.7 +/- 0.2, to 1.4 +/- 0.2, to 1.3 +/- 0.2) and percentage of akinesia (30.4 +/- 7.5 to 29.3 +/- 4.2, to 19.8 +/- 11.6, to 14.5 +/- 7.2) which slowly and significantly improved suggesting a positive post-surgery remodeling.
  
  
  CONCLUSIONS
  Ventricular reconstruction caring of physiological shape, volume, revascularization and residual akinesia obtained a steady geometry. Positive remodeling and equalization of geometrical outcome may persistently prevent long-term redilation.
authors.affiliation: Department of Cardiovascular Surgery, Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy. mkyr@libero.it
authors.forename: Marco
authors.initials: M
authors.lastname: Cirillo
authors.forename: Andrea
authors.initials: A
authors.lastname: Amaducci
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Villa
authors.forename: Margherita Dalla
authors.initials: MD
authors.lastname: Tomba
authors.forename: Federico
authors.initials: F
authors.lastname: Brunelli
authors.forename: Zen
authors.initials: Z
authors.lastname: Mhagna
authors.forename: Giovanni
authors.initials: G
authors.lastname: Troise
authors.forename: Eugenio
authors.initials: E
authors.lastname: Quaini
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016896:Treatment Outcome; D016277:Ventricular Function, Left