title: Spherical dilatation of the apex in failing left ventricles: a target for surgical remodelling techniques.
abstract: OBJECTIVE
  The present study investigates the geometry of failing left ventricles with a special focus on apical deformation. A new surgical remodelling technique is evaluated.
  
  
  METHODS
  In 124 patients with impaired left ventricular function (EF<40%) undergoing coronary artery bypass grafting (CABG) left ventricular (LV) geometry was evaluated by MRI scanning before and after surgery. Besides the sphericity index (SI) two further indices were calculated, longitudinal EF (LEF) and an apical conicity index (ACI). The results were compared to 15 patients with coronary heart disease and normal LV function and 10 test persons. In 35 patients with impaired LV function perpendicular apical compression (AC) stitches were placed.
  
  
  RESULTS
  In failing left ventricles indexed LV length increased (5.3 ± 0.6 cm/m2 vs. 4.7 ± 0.8 cm/m2 in control patients and 4.6 ± 0.3 cm/m2 in test persons, P=0.03). LEF was reduced (6% ± 4 versus 22% ± 6 and 19% ± 7 P=0.04). The classical SI was 0.56 ± 0.06 in heart failure patients, 0.50 ± 0.05 in control patients and 0.48 ± 0.04 in test persons. The ACI were 0.75 ± 0.06, 0.58 ± 0.06 and 0.57 ± 0.04 respectively (P<0.05), indicating a pronounced dilatation at the apex. After apical compression LEF improved to 15 ± 1%, the ACI to 0.64 ± 0.04 (P=0.04). LVEDV (166 ± 11 mL [AC] vs. 196 ± 14 mL [without AC]) as well as LV-EF (48 ± 3% [AC] vs. 36 ± 2% [without AC]) significantly improved only after remodelling (P<0.05).
  
  
  CONCLUSIONS
  Apical compression improved ventricular geometry and ventricular function in patients with dialatation of the left ventricular apex.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, J. W. Goethe University, Frankfurt am Main, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Monsefi
authors.forename: A
authors.initials: A
authors.lastname: Zierer
authors.forename: F
authors.initials: F
authors.lastname: Bakhtiary
authors.forename: Th
authors.initials: T
authors.lastname: Vogl
authors.forename: H
authors.initials: H
authors.lastname: Ackermann
authors.forename: P
authors.initials: P
authors.lastname: Kleine
authors.forename: A
authors.initials: A
authors.lastname: Moritz
authors.forename: O
authors.initials: O
authors.lastname: Dzemali
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013318:Stroke Volume; D013536:Suture Techniques; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling