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J Thorac Cardiovasc Surg 2009;137:887-894
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Why is the surgical ventricular restoration operation effective for ischemic cardiomyopathy? Geometric analysis with magnetic resonance imaging of changes in regional ventricular function after surgical ventricular restoration

^a Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
^b Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
^c Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan

Received for publication April 11, 2008; revisions received July 24, 2008; accepted for publication September 16, 2008.

^_* Address for reprints: Fang-Yue Lin, MD, PhD, Department of Surgery, National Taiwan University Hospital, No. 7, Chung-Shan S Rd, Taipei, Taiwan 100, Republic of China. (Email: fylin{at}ntuh.gov.tw).

Objective: Clinical improvement after a surgical ventricular restoration for ischemic cardiomyopathy is increasingly accepted by clinicians, but the mechanism is not completely understood.

Methods: Ten patients with ischemic cardiomyopathy underwent detailed magnetic resonance imaging for ventricular function before and 6 weeks after surgical ventricular restoration. Surgical procedures included combinations of coronary artery bypass grafting, restrictive mitral annuloplasty, and endoventricular patch plasty. Magnetic resonance imaging analysis included quantification of global and regional systolic function. Anterior and posterior left ventricular regions were divided by an imaginary plane (C-plane) determined from anterior mitral point and both papillary roots.

Results: Global stroke volume index increased from 28.8 ± 4.9 mL/m² to 36.5 ± 8.6 mL/m² after surgical ventricular restoration (P = .010) and seemed more related to increased posterior stroke volume index (15.9 ± 4.3 mL/m² preoperatively, 21.8 ± 3.9 mL/m² postoperatively, P = .001) than to changed anterior stroke volume index (15.9 ± 4.4 mL/m² preoperatively, 18.2 ± 6.9 mL/m² postoperatively, P = .369). C-plane area decreased only a little in diastole (37.7 ± 8.3 cm² preoperatively, 32.9 ± 5.9 cm² postoperatively, P = .119) but significantly in systole (31.5 ± 9.4 cm² preoperatively, 23.7 ± 7.6 cm² postoperatively, P = .023). This indicates functional recovery of border zone by restrictive endoventricular patch plasty.

Conclusion: Rebuilding geometric normality by surgical ventricular restoration improves contractility of myocardium in border-zone and remote regions, resulting in increased stroke volume index from the posterior left ventricle.