[Surgical restoration of left ventricle after myocardial infarction]

Heart failure is currently one of the biggest problems of all heath care systems in the world and will become even more important. In about 50% of the patients, heart failure is a consequence of myocardial infarction. The surgical reconstruction of the left ventricle after anterior myocardial infarction became the first effective method of treatment which can be applied in many patients. After anterior myocardial infarction the apical part of the ventricle dilates, becomes more spherical with thinned wall. Dilated, spherical apex results in rise of wall tension of the transition zone between the apex and the proximal part of the left ventricle. This increases oxygen demand and reduces coronary blood flow. This phenomenon is responsible for severe angina pectoris and explains why myocardial infarction is the most common cause of death of patients with LV aneurysm. Increased wall tension of the transition zone leads to fibrosis, further dilatation and decrease of contractility of the left ventricle. Only surgical reconstruction of the left ventricle can stop this progressive process. The aim of surgery is to decrease the wall tension by restoring the normal elliptical shape, geometry and volume of the left ventricle. Results of this operation are very promising. Perioperative mortality is about 5% and 5-year survival 80%.