Document Detail

Ventricular radius reduction without resection: a computational analysis.
MedLine Citation:
PMID:  10360716     Owner:  NLM     Status:  MEDLINE    
Reducing a dilated left ventricle's radius by wedge resection lowers wall stress, improving performance. However, compliance falls, stroke volume improvement is limited, and, later, both functional deterioration and serious dysrhythmias are frequent. These all may result from loss of circumference, loss of contractile mass, and myocardial trauma, none of which would occur in geometric remodeling. One specific technique is bimeridianal restraint, which uses two indenting bars to remodel the left ventricle (LV) as two widely communicating "lobes" of reduced radius. Computational analysis of this technique, applied to the dilated ventricular dimensions of four pretransplant patients, showed that 20% radius reduction would be accomplished by two < or =18 mm wide bars, indenting the epicardium < or =8.3 mm with < or =6.4 mm greatest outward displacement. Projected stroke volume (SV) for the subject ventricles was then modeled and compared with projections for resected ventricles. Assuming that equally improved contractile fraction will follow equal radius reduction, however that reduction is accomplished, improvement is dramatic: if postresection remodeling SV were 1.0, 1.2, or 1.5 times baseline, then postgeometric remodeling SV would be 1.36+/-0.06, 1.66+/-0.05, or 2.14+/-0.04 times baseline, respectively. These results, preservation of contractile mass and circumferential length, complete reversibility, and minimal operative trauma, warrant study of implementing mechanical designs.
D B Melvin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  ASAIO journal (American Society for Artificial Internal Organs : 1992)     Volume:  45     ISSN:  1058-2916     ISO Abbreviation:  ASAIO J.     Publication Date:    1999 May-Jun
Date Detail:
Created Date:  1999-07-22     Completed Date:  1999-07-22     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  9204109     Medline TA:  ASAIO J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  160-5     Citation Subset:  IM    
Department of Surgery, University of Cincinnati, Ohio, USA.
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MeSH Terms
Cardiac Surgical Procedures / methods*
Heart Failure / pathology,  surgery*
Heart Ventricles / pathology,  surgery*
Models, Cardiovascular*
Stroke Volume
Ventricular Function
Ventricular Function, Left

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