Heart failure following anterior myocardial infarction: an indication for ventricular restoration, a surgical method to reverse post-infarction remodeling

Heart Fail Rev. 2004 Oct;9(4):241-54. doi: 10.1007/s10741-005-6802-7.

Abstract

Anterior myocardial infarction produces abrupt left ventricular (LV) dysynergy and global systolic dysfunction. Rapid intense neurohumoral activation, infarct expansion, and early ventricular chamber dilatation all contribute to restoring a normal stroke volume despite a persistently depressed ejection fraction. Continued neurohumoral activation provokes late remodeling of the remote non-infarcted myocardium, characterized by an abnormal progressively increasing LV volume/mass ratio that leads to further LV remodeling. Heart failure is a progressive disorder of LV remodeling. Heart failure from post-infarction remodeling is unique because of the persistent non-functioning scar that self- perpetuates abnormal loading conditions and neurohumoral activation. Medical therapy attenuates remodeling and improves survival but does not change the size of the scar. Surgical ventricular restoration to exclude the non-functioning infarct from the ventricular cavity decreases ventricular volumes, increases global ejection fraction, attenuates neurohumoral activation and yields an excellent 5-year survival. Combined medical and surgical therapy is recommended in this patient population.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Endocardium / physiopathology
  • Endocardium / surgery
  • Heart Failure / etiology
  • Heart Failure / physiopathology*
  • Heart Failure / surgery*
  • Heart Ventricles / physiopathology
  • Heart Ventricles / surgery
  • Humans
  • Myocardial Infarction / complications*
  • Ventricular Dysfunction, Left / etiology
  • Ventricular Dysfunction, Left / physiopathology*
  • Ventricular Dysfunction, Left / surgery*
  • Ventricular Remodeling / physiology*