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J Thorac Cardiovasc Surg 2002;124:886-890
© 2002 The American Association for Thoracic Surgery
Editorials |
From San Donato Hospital, Milan, Italy,a and the Department of Critical Care Medicine, University of Florence, Florence, Italy.b
Received for publication June 27, 2002. Accepted for publication July 1, 2002. Address for reprints: Lorenzo Menicanti, MD, Chief in Cardiac Surgery, Istituto Policlinico San Donato, Cardiac Surgery, Via Morandi 30, San Donato Milanese 20097, Italy.
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Introduction |
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Heart failure is a major health problem with increasing prevalence due partly to an aged population and more effective treatment of acute myocardial infarction. Postinfarction left ventricular remodeling is characterized by chamber dilatation and abnormal shape leading to systolic and diastolic dysfunction. In advanced form, it leads to the heart failure syndrome and is progressive. Intensive medical management reduces symptoms and improves survival. However, patients who are in functional class III or IV have a poor 3-year prognosis.
1-3 Recently, surgical approaches have been designed to abort and reverse remodeling, diminish heart failure, and improve survival. With minor modifications, this surgical approach uses the Dor procedure.
Surgical therapy achieves the following:
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History of the Dor procedure |
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4-7 The Dor procedure excludes akinetic or dyskinetic portions of the ventricle, reshapes the ventricle with a stitch that encircles the transitional zone between contractile and noncontractile myocardium, and uses a small patch to reestablish ventricular wall continuity at the level of the purse-string suture.
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Pathophysiology of postinfarction remodeling |
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J. Thorac. Cardiovasc. Surg. 2002 124: 863-883.
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