ABSTRACT
In patients with left ventricular end diastolic dimensions >5--< or =5.5 cm myocardial revascularization was associated with significant decreases of diastolic and systolic left ventricular dimensions in immediate postoperative period. This adaptational phenomenon was called passive reducing left ventricular remodeling. In patients with left ventricular end diastolic dimensions <5 and >5.5 cm revascularization was associated with dilation of the left ventricle. Restoration of myocardial blood supply produced overall positive effect on left ventricular functional capacity in patients with various severity of its postinfarction remodeling. Pathways of realization of this positive effect could be different.
Subject(s)
Coronary Artery Bypass , Ventricular Remodeling , Adult , Aged , Coronary Circulation , Data Interpretation, Statistical , Diastole , Echocardiography , Female , Hemodynamics , Humans , Male , Middle Aged , Postoperative Period , Ventricular Function, LeftABSTRACT
Intergroup analysis of parameters of central hemodynamics in the process of increase of left ventricular dimensions has shown that changes of pump function of the heart correspond to stages of left ventricular remodeling after myocardial infarction. Decreases of ejection fraction and cardiac output occur in patients with postinfarction aneurysm. At various stages of pathogenesis of remodeling multiple factors facilitate adaptation to novel conditions of functioning. They include structural reorganization of ventricular wall, hypertrophy of myocytes, and augmentation of muscular mass without wall thickening (exocentric hypertrophy). At other equal conditions characteristic for the patients studied starting point of maladaptational left ventricular remodeling and consequent development of cardiac failure can be value of left ventricular diastolic volume 182.7+/-3.28 ml. This volume according to data obtained by the authors represents a threshold over which 'rescue' for the body Staring law is not able to maintain adequate stroke volume and cardiac output.
Subject(s)
Myocardial Infarction/complications , Myocardial Infarction/physiopathology , Myocardium/pathology , Ventricular Remodeling/physiology , Acute Disease , Adult , Aged , Female , Hemodynamics/physiology , Humans , Hypertrophy/etiology , Hypertrophy/pathology , Male , Middle Aged , Time FactorsABSTRACT
Functional importance of left ventricular endoventricular plastic repair in postinfarction aneurysms are discussed. It is proposed to apply vascularized muscle flap consisting of middle and internal myocardial layers as the patch. This policy permits to ensure structural-geometrical optimization of left ventricle and to increase left ventricle contractility due to involvement of automyocardial patch into active contraction.
