Ventricular Geometry in Post-Myocardial Infarction Aneurysms Implications for Surgical Ventricular Restoration

The topic of heart failure although extensively researched and reported, has several gray areas. This is especially seen in determining strategies for combating advanced heart failure. The global burden of ischemic heart disease is increasing at an alarming rate to almost pandemic proportions. Even in the presence of state-of the art technology for prompt and successful coronary reperfusion, the population progressing to ischemic cardiomyopathy is substantial. The treatment strategies for ischemic cardiomyopathy do not always ensure optimal clinical results, the reasons for which are varied. The proper patient selection is vital as is the tailoring of suitable therapy. The approach is thus multi-pronged, of which surgical ventricular restoration (SVR) has a definite role. Despite various randomized studies like the STICH-hypothesis 2, where there was a huge selection bias, with patients subjected to an erroneous technique of SVR, with inadequate ventricular remodelling assessment. The present need is to understand the unique anatomy of the left ventricle, its function and perturbations with the onset of heart failure, in order to plan therapeutic strategies to restore near normal anatomy and function. A study of the hemodynamics in ischemic cardiomyopathy is essential, as it differs in certain aspects from other causes of heart failure like idiopathic dilated cardiomyopathy and valvular heart diseases. Since information on these aspects are scattered in various scholarly articles, a concise source in the form of a book would be appropriate and useful for both cardiologists and cardiac surgeons. This project represents a concise review of normal and abnormal cardiac anatomy and physiology, the evolution of SVR to EVLPP with validation of near normal ventricular restoration, plus act as a reference guide for cardiac surgeons with interest in SVR.

1.Foreword.- 2.Preface.-3.Architecture of the normal heart.- 4.The normal mechanisms of cardiac contraction and relaxation.- 5.Alterations in cardiac geometry with heart failure.- 6.Perturbations in contraction and relaxation with heart failure.- 7.Hemodynamics in ischemic cardiomyopathy.- 8.History of surgical ventricular restoration.- 9.Evolution of surgical ventricular restoration to endoventricular linear patch plasty(EVLPP).- 10.Validation of near physiological restoration of left ventricular geometry by EVLPP.- 11.Physiological considerations in the relationships of left ventricular volumes.- 12.Evidence of an extension of Frank Starling mechanism in the failing heart.- 13.Concomitant procedures with surgical ventricular restoration: Indications and techniques.