Inferior wall restoration: anatomic and surgical considerations

Congestive heart failure that results from inferior infarction is caused by a triangular change in ventricular geometry, which involves the septum, lateral wall, and base supplied by the right coronary artery. The extent of damage is determined by the anatomic distribution of coronary blood flow. Mitral insufficiency is accentuated from damage to the basal region, especially when the occluded right coronary vessel has multiple inferior branches and wraps around the apex. Three methods of repair are described, and include direct restoration without a patch, patch repair of the triangular scar, or use of a retriangulation suture in ventricles with trabecular scar to imbricate the noncontractile region to restrict patch size. This triangular reduction in size mirrors the design concept for suture described by Fontan in anterior infarction, which produces an oval apex. Early results in relation to left ventricular end systolic volume index and ejection fraction are defined.