[Antagonistic function of the heart muscle : Part II: Clinical implications]. / Die antagonistische Funktion des Herzmuskels : Teil II: Klinische Auswirkungen.

In the hypertrophic heart the myostructural afterload in the form of endoepicardial networks is predominant, which enhances myocardial hypertrophy. The intrinsic antagonism is derailed. Likewise, the connective tissue scaffold, i.e. the stromatogenic afterload, is enriched in the response to the derailment of antagonism in a hypertrophic heart up to regional captivation of the heart musculature. Due to the selective susceptibility of the auxotonic, contracting oblique transmural myocardial network for low dose negative inotropic medication, this promises to attenuate progress in myocardial hypertrophy. Volume reduction surgery is most effective in reducing wall stress as long as the myocardium is not critically fettered by fibrosis. The use of external mechanical circulatory support is then effective if the heart is supported in its resting mode, which means around a middle width and at minimal amplitude of motion. The takotsubo cardiomyopathy might possibly reflect an isolated, extreme stimulation of the intrinsic antagonism as a response to hormonally induced sensitization of the myocardium to catecholamine. A particular significant conclusion with respect to the diseased heart is that clinical diagnostics need new impulses with a focus on the analysis of local motion patterns and on myocardial stiffness reflecting disease-dependent antagonistic intensity. This would become a relevant diagnostic marker if corresponding (noninvasive) measurement techniques would become available.

Ventriculectomia parcial em criança: técnica de Batista / Partial ventriculectomy in a child: the Batista Operation

Criança com dois anos e seis meses de idade, apresentando cardiomiopatia dilatada idiopática, classe funcional III-IV (New York Heart Association - NYHA) e indicaçäo de transplante cardíaco, foi submetida à ventriculectomia radioisotópica (Gated Blood Pool) revelaram fraçäo de ejeçäo de ventrículo esquerdo (FEVE) de 13 'por cento' e 20 'por cento', respectivamente. Após a cirurgia, que consistiu na remoçäo de uma parte do músculo da parede lateral do ventrículo esquerdo, a FEVE foi para 50 'por cento' pelo ECO e 30 'por cento' pela ventriculografia radioisotópica. A criança recebeu alta hospitalar no 16§ pós-operatório em classe funcional I (NYHA).