Differentiated approach to surgical treatment of left ventricular postinfarction remodeling
Watolina T. V., Lezhnev А. А., Shipulin V. M., Vaizov V. Kh.
Keywords: myocardial infarction, remodeling, surgical treatment
Relevance. The question of necessity of LV reconstructive surgeries in patients with postinfarction remodeling is under discussion. Objective. Results of LV reconstructive surgeries, depending on an initial type of postinfarction remodeling, presence diastolic dysfunctions, were studied. Materials and methods. The subjects studied were 112 patients with CHD who suffered one or more MIs, with LVEF less than 45%. Results of reconstructive surgeries were compared with the results of isolated coronary artery bypass surgery in patients with the 2nd and 3rd types of postinfarction remodeling by Di Donato classification. Results. The necessity of reconstructive surgeries in patients with the 1st and 2nd types of postinfarction remodeling was shown, as well as inexpediency to reduce LV cavity in patients with the 3rd type of postinfarction remodeling. The role of stroke volume was revealed in the evaluation reconstructive surgery effectiveness as well as relation of surgical mortality with diastolic dysfunction before surgery. Conclusion. To devise tactics of surgical treatment of patients with postinfarction remodeling, it is necessary to define its type. At the 1st and 2nd types, it is necessary to perform reconstruction of LV cavity, observing the rules allowing preserving cone-shaped LV cavity. At the 3rd type of postinfarction remodeling, revasculization and correction of valvular insufficiency are indicated. At presence restrictive diastolic dysfunction at all types of postinfarction remodeling, it advisable to exclude (whenever possible) the restriction of LV, it is more preferable to reduction the intervention to revasculization.
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Watolina T. V., Lezhnev А. А., Shipulin V. M., Vaizov V. Kh. Differentiated approach to surgical treatment of left ventricular postinfarction remodeling. Russian Heart Journal. 2012;11(2):99-102