Early surgical anteroseptal ventricular endocardial restoration after acute myocardial infarction. Pathophysiology and surgical considerations

Pino Fundarò, Marco Pocar, Giovanni Marchetto, Andrea Moneta, Roberto Mattioli, Francesco Donatelli, Adalberto Grossi

Research output: Contribution to journalArticle

Abstract

Background. The efficacy and safety of surgical anteroseptal ventricular endocardial restoration (a procedure that excludes non-contracting scarred segments) in the left ventricle with chronic dilation and remodeling secondary to an anterior myocardial infarction are well established. We present a small series and discuss the indication for early left ventricular restoration in the setting of complicated acute myocardial infarction. Methods. Early ventricular restoration was performed in 8 patients (4 males, 4 females, mean age 70 ± 8 years). A postinfarction ventricular septal defect was diagnosed in 3 cases. All patients were operated, on an urgent or emergent basis, between 1 and 16 days following the onset of infarction. Surgical coronary revascularization was associated in 7 patients. Results. There was one operative death. At discharge, echocardiographic morphofunctional assessment revealed: a reduction of the left ventricular end-diastolic and end-systolic volume indexes, an increase of the ejection fraction, and, most importantly, an improvement of remote myocardial shortening fraction. At a mean follow-up of 15.6 months (range 2-21 months), there were no late deaths and all survivors are in NYHA functional class I or II. Conclusions. Left ventricular restoration may represent an effective adjunct to the surgical management of patients with an acute extensive anterior myocardial infarction complicated by severe heart failure, with or without septal rupture.

Original languageEnglish
Pages (from-to)252-256
Number of pages5
JournalItalian Heart Journal
Volume4
Issue number4
Publication statusPublished - Apr 1 2003

Keywords

  • Myocardial infarction
  • Surgery
  • Ventricular function
  • Ventricular remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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