A Brief Assessment of Myocardial Viability in Surgically Remodeled Hearts

Authors: Rabbany S.Y.¹; Danielsen M.²; Noordergraaf A.³

Source: Cardiovascular Engineering: An International Journal, Volume 1, Number 3, September 2001 , pp. 155-161(7)

Publisher: Springer

Abstract:

Partial left ventriculectomy (PLV)constitutes a new surgical procedure that is postulated to improve cardiac pump function in patients with end-stage heart failure. PLV is undergoing trials in a number of clinics with, thus far, disappointing rates of success. It remains to be seen whether PLV works, and if so how. Consequently, a number of basic questions have been raised. Three of these will be addressed in this report: (1) can a reason be identified to explain why the heart enlarges progressively as its failure becomes gradually more severe; (2) should final selection of patients, considered for PLV, be based on the remaining (left) ventricular contractile properties as estimated from the ventricle's pressure–volume diagram; and (3) if this popular method of estimation is found to be deficient, can a new approach be designed? It is concluded that (1) ventricular enlargement requires less wall muscle shortening to produce a normal stroke volume, suggesting that enlargement is nature's way to facilitate pumping by an impaired contractile mechanism, (2) the contractile properties play a role in defining the pressure–volume (work) loop, but they are not retrievable, and (3) a different methodology is developed to estimate contractile properties continuously for the entire heart cycle.

Keywords: cardiomyopathy; partial left ventriculectomy; Batista's procedure; allometric scaling relations; pressure–volume loop; ventricular elastance (compliance)

Language: English

Document Type: Regular paper

Affiliations: 1: Bioengineering Program, Hofstra University, Hempstead, New York 11549-1330; sina.y.rabbany@hofstra.edu 2: Department of Engineering, Trinity College, Hartford, Connecticut 06106-3100 3: Cardiovascular Studies Unit, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6392

Publication date: 2001-09-01

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• In this Subject: Cardiovascular Medicine ,  Pathology ,  Pharmacology
• By this author: Rabbany S.Y. ;  Danielsen M. ;  Noordergraaf A.

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