Seeing congestive heart failure with the eyes of the mind: a surgical view

Our normal approach is to recognize pathology and deal with what we see. This article shows that surgical actions in patients with congestive heart failure (CHF) are based on secondary changes in apparently normal looking structures that must be altered to restore normal function. These interventions follow the process of opening the normal pericardium to deal with the abnormal heart. Recognition of conceptual changes in structures without obvious pathology will lead to our incising the normal epicardium to deal with the scarred underlying muscle, narrowing the normal annulus to alter tethering of the lengthened papillary muscle chord connections, imbricating dilated normal myocardium between papillary muscle heads to narrow secondary widening, and rebuilding the dilated spheric ventricle to restore a normal elliptic contour. The overall objective is make our mental concepts guide surgical activities, and thus go beyond evident pathology in our corrective efforts. Our intent is to escape the boundary of the visible disease, and aim restoration toward the boundary of normality.