Heart Failure Reviews

, Volume 9, Issue 4, pp 241–254

Heart Failure Following Anterior Myocardial Infarction: An Indication for Ventricular Restoration, a Surgical Method to Reverse Post-Infarction Remodeling

  • Alfred W. H. StanleyJr.
  • Constantine L. Athanasuleas
  • Gerald D. Buckberg
  • The RESTORE Group
Article

DOI: 10.1007/s10741-005-6802-7

Cite this article as:
Stanley, A.W.H., Athanasuleas, C.L., Buckberg, G.D. et al. Heart Fail Rev (2005) 9: 241. doi:10.1007/s10741-005-6802-7

Abstract

Anterior myocardial infarction produces abrupt left ventricular (LV) dysynergy and global systolic dysfunction. Rapid intense neurohumoral activation, infarct expansion, and early ventricular chamber dilatation all contribute to restoring a normal stroke volume despite a persistently depressed ejection fraction. Continued neurohumoral activation provokes late remodeling of the remote non-infarcted myocardium, characterized by an abnormal progressively increasing LV volume/mass ratio that leads to further LV remodeling.

Heart failure is a progressive disorder of LV remodeling. Heart failure from post-infarction remodeling is unique because of the persistent non-functioning scar that self- perpetuates abnormal loading conditions and neurohumoral activation. Medical therapy attenuates remodeling and improves survival but does not change the size of the scar. Surgical ventricular restoration to exclude the non-functioning infarct from the ventricular cavity decreases ventricular volumes, increases global ejection fraction, attenuates neurohumoral activation and yields an excellent 5-year survival. Combined medical and surgical therapy is recommended in this patient population.

Keywords

post infarction remodelingneuroendocrine factorsinfarction scarLV culprit muscleremote muscleventricular volumefunctional mitral regurgitationsurgical ventricular restorationSVRventricular restoration

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Alfred W. H. StanleyJr.
    • 1
  • Constantine L. Athanasuleas
    • 1
  • Gerald D. Buckberg
    • 2
    • 3
  • The RESTORE Group
  1. 1.Kemp-Carraway Heart Institute and Center for Heart Failure ManagementCarraway Methodist Medical CenterBirminghamUSA
  2. 2.David Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.School of Medicine at UCLALos AngelesUSA