Document Detail


Analysis of patient-specific surgical ventricular restoration: importance of an ellipsoidal left ventricular geometry for diastolic and systolic function.
MedLine Citation:
PMID:  23640586     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Surgical ventricular restoration (SVR) is a procedure designed to treat heart failure by surgically excluding infarcted tissues from the dilated failing left ventricle. To elucidate and predict the effects of geometrical changes from SVR on cardiac function, we created patient-specific mathematical (finite-element) left ventricular models before and after surgery using untagged magnetic resonance images. Our results predict that the postsurgical improvement in systolic function was compromised by a decrease in diastolic distensibility in patients. These two conflicting effects typically manifested as a more depressed Starling relationship (stroke volume vs. end-diastolic pressure) after surgery. By simulating a restoration of the left ventricle back to its measured baseline sphericity, we show that both diastolic and systolic function improved. This result confirms that the increase in left ventricular sphericity commonly observed after SVR (endoventricular circular patch plasty) has a negative impact and contributes partly to the depressed Starling relationship. On the other hand, peak myofiber stress was reduced substantially (by 50%) after SVR, and the resultant left ventricular myofiber stress distribution became more uniform. This significant reduction in myofiber stress after SVR may help reduce adverse remodeling of the left ventricle. These results are consistent with the speculation proposed in the Surgical Treatment for Ischemic Heart Failure trial (20) for the neutral outcome, that "the lack of benefit seen with surgical ventricular reconstruction is that benefits anticipated from surgical reduction of left ventricular volume (reduced wall stress and improvement in systolic function) are counter-balanced by a reduction in diastolic distensibility."
Authors:
Lik Chuan Lee; Jonathan F Wenk; Liang Zhong; Doron Klepach; Zhihong Zhang; Liang Ge; Mark B Ratcliffe; Tarek I Zohdi; Edward Hsu; Jose L Navia; Ghassan S Kassab; Julius M Guccione
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2013-05-02
Journal Detail:
Title:  Journal of applied physiology (Bethesda, Md. : 1985)     Volume:  115     ISSN:  1522-1601     ISO Abbreviation:  J. Appl. Physiol.     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-07-02     Completed Date:  2013-10-17     Revised Date:  2014-07-01    
Medline Journal Info:
Nlm Unique ID:  8502536     Medline TA:  J Appl Physiol (1985)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  136-44     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Blood Pressure / physiology
Coronary Artery Bypass
Diastole / physiology
Finite Element Analysis
Heart Ventricles / physiopathology,  surgery*
Hemodynamics / physiology
Humans
Image Processing, Computer-Assisted
Magnetic Resonance Imaging
Systole / physiology
Thoracic Surgery*
Ventricular Function, Left / physiology
Grant Support
ID/Acronym/Agency:
HL-084529/HL/NHLBI NIH HHS; R01 HL-077921/HL/NHLBI NIH HHS; R01 HL-084431/HL/NHLBI NIH HHS; R01 HL-086400/HL/NHLBI NIH HHS; R01 HL077921/HL/NHLBI NIH HHS; R01 HL086400/HL/NHLBI NIH HHS
Comments/Corrections

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