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

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 remodeling neuroendocrine factors infarction scar LV culprit muscle remote muscle ventricular volume functional mitral regurgitation surgical ventricular restoration SVR ventricular restoration 

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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

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