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A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle

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 resto...

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Autores principales: Cirillo, Marco, Amaducci, Andrea, Villa, Emmanuel, Tomba, Margherita Dalla, Brunelli, Federico, Mhagna, Zen, Troise, Giovanni, Quaini, Eugenio
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2006
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1636045/
https://www.ncbi.nlm.nih.gov/pubmed/17083734
http://dx.doi.org/10.1186/1749-8090-1-40
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author Cirillo, Marco
Amaducci, Andrea
Villa, Emmanuel
Tomba, Margherita Dalla
Brunelli, Federico
Mhagna, Zen
Troise, Giovanni
Quaini, Eugenio
author_facet Cirillo, Marco
Amaducci, Andrea
Villa, Emmanuel
Tomba, Margherita Dalla
Brunelli, Federico
Mhagna, Zen
Troise, Giovanni
Quaini, Eugenio
author_sort Cirillo, Marco
collection PubMed
description 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 ≤ 45 mL/m(2 )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. CONCLUSION: 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.
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spelling pubmed-16360452006-11-15 A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle Cirillo, Marco Amaducci, Andrea Villa, Emmanuel Tomba, Margherita Dalla Brunelli, Federico Mhagna, Zen Troise, Giovanni Quaini, Eugenio J Cardiothorac Surg Research Article 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 ≤ 45 mL/m(2 )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. CONCLUSION: 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. BioMed Central 2006-11-03 /pmc/articles/PMC1636045/ /pubmed/17083734 http://dx.doi.org/10.1186/1749-8090-1-40 Text en Copyright © 2006 Cirillo et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Cirillo, Marco
Amaducci, Andrea
Villa, Emmanuel
Tomba, Margherita Dalla
Brunelli, Federico
Mhagna, Zen
Troise, Giovanni
Quaini, Eugenio
A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle
title A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle
title_full A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle
title_fullStr A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle
title_full_unstemmed A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle
title_short A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle
title_sort new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1636045/
https://www.ncbi.nlm.nih.gov/pubmed/17083734
http://dx.doi.org/10.1186/1749-8090-1-40
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