Document Detail


'Let's twist again': surgically induced renewal of left ventricular torsion in ischemic cardiomyopathy.
MedLine Citation:
PMID:  19834328     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To test the potential of the heart to be surgically restored at a near-normal global condition, granted that its physiological characteristics are respected (working volumes, chamber geometry, fiber orientation, opposite rotation of apex and base, global torsion and strain). METHODS: From May 2007 to December 2008, 12 consecutive patients with ischemic cardiomyopathy were included in this study. All patients underwent modified surgical anterior ventricular restoration combined with complete coronary revascularization and, when indicated, mitral anuloplasty. The modified restoration aims to re-approach residual myocardium, redirecting fiber orientation displaced by infarct scar toward a more physiological gross disposition. Patients were studied preoperatively and postoperatively with a complete echocardiographical assessment, including speckle-tracking analysis. RESULTS: Standard parameters significantly improved after the operation (end diastolic volume, P < 0.001; end systolic volume, P < 0.001; ejection fraction, P = 0.004), and so did peak systolic apical rotation, peak systolic left ventricular torsion and two-chamber and four-chamber longitudinal strain (P = 0.004, 0.003, 0.05 and 0.01, respectively). Pearson's correlation between apical rotation and longitudinal strain (two-chamber and four-chamber) was -0.877 (P < 0.001) and -0.720 (P = 0.008), respectively, and between torsion and longitudinal strain was -0.845 (P = 0.001) and -0.785 (P = 0.002), respectively. CONCLUSION: This study reveals an unexpected potential of the myocardium to be restored at a near-normal global condition, with regard to all of its physiological characteristics. The concept of fiber-based surgical treatment, supported by an imaging-guided preoperative study, could widen the potential of repairing a failing heart.
Authors:
Marco Cirillo; Marco Campana; Federico Brunelli; Margherita Dalla Tomba; Zean Mhagna; Antonio Messina; Emmanuel Villa; Giovanni Troise
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiovascular medicine (Hagerstown, Md.)     Volume:  11     ISSN:  1558-2035     ISO Abbreviation:  J Cardiovasc Med (Hagerstown)     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-11-25     Completed Date:  2010-01-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101259752     Medline TA:  J Cardiovasc Med (Hagerstown)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  34-9     Citation Subset:  IM    
Affiliation:
Heart Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy. cirillo-marco@poliambulanza.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cardiac Surgical Procedures*
Cardiomyopathies / etiology,  physiopathology,  surgery*,  ultrasonography
Female
Humans
Male
Middle Aged
Myocardial Contraction
Myocardial Ischemia / complications,  physiopathology,  surgery*,  ultrasonography
Pilot Projects
Recovery of Function
Stroke Volume
Torsion Abnormality / etiology,  physiopathology,  surgery*,  ultrasonography
Torsion, Mechanical
Treatment Outcome
Ventricular Dysfunction, Left / etiology,  physiopathology,  surgery*,  ultrasonography
Ventricular Function, Left*

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