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Causes of repeated remodeling of left ventricle after Dor procedure

Vladimir M Shipulin1, Vitaly A Kazakov, Irina V Suhodolo

  • 1Cardio-vascular Department, Tomsk Institute of Cardiology, Kievskaya street 111a, Tomsk, Russia, 634012. shipulin@cardio.tsu.ru

Interactive Cardiovascular and Thoracic Surgery
|September 22, 2007
PubMed

Insights

Morphological factors like fibrosis and inflammation in the left ventricle (LV) predict poor outcomes after surgery for ischemic cardiomyopathy (ICMP). Identifying these factors can improve patient selection and surgical planning for better results.

Area of Science:

  • Cardiology
  • Pathology
  • Surgical Treatment

Background:

  • Ischemic cardiomyopathy (ICMP) with left ventricle (LV) aneurysm presents significant surgical challenges.
  • Predicting postoperative outcomes in ICMP patients is crucial for effective treatment planning.

Purpose of the Study:

  • To identify morphological predictors of unfavorable follow-up outcomes in patients undergoing surgical treatment for ICMP with LV aneurysm.
  • To analyze intraoperative myocardial and atrial biopsies for risk factors associated with postoperative remodeling.

Main Methods:

  • Biopsy analysis of LV myocardium and right atrium (RA) auricle from 36 ICMP patients.
  • Assessment of morphometrical parameters including parenchymal-stromal ratio (PSR), trophic index (TI), pericapillar diffusion zone (PDZ), and Kernogan index (KI).
  • Evaluation of specific volume of natriuretic factor (NUF) granules in atrial cardiomyocytes.

Main Results:

  • Postoperative improvement in LV ejection fraction (EF) and decrease in end-diastolic volume (EDV) were observed initially.
  • Unfavorable remodeling occurred in 8 patients, characterized by decreased LV EF and increased LV EDV.
  • Diffuse inflammation, severe fibrosis (PSR<1.5), low TI (<0.015), high PDZ (>1000 microm), and high KI (>1.6) in LV myocardium were linked to poor outcomes.
  • An inverse correlation was found between NUF granule content and the success of the Dor procedure.

Conclusions:

  • A combination of specific morphological features in LV myocardium serves as a predictor of adverse postoperative heart remodeling in ICMP patients.
  • These findings can aid in refining patient selection and surgical strategies for ICMP treatment.
Abstract

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