Left ventricular remodelling
The heart has 4 chambers into which blood flows and is pumped around the body. Occasionally people who have suffered a heart attack (myocardial infarction) can develop an aneurysm in their heart wall. This most commonly occurs in a chamber on the lower left side of the heart called the left ventricle. Left ventricular aneurysms arise in an area of weakened wall tissue and cause the wall to inappropriately bulge outwards.
As a consequence the bottom left chamber of the heart cannot squeeze blood out and around the body very effectively. This can lead to heart failure. If a left ventricular aneurysm leads to an irregular heartbeat or to heart failure, the surgeon may perform open heart surgery to remove the damaged part of the wall.
The procedure uses special “mannequins” that help to reconstruct the left ventricle to form a cone-shape, they also protect the surgeon from “overcorrecting” the problem. This type of surgery is usually performed along with coronary by-pass surgery and surgery of the mitral valve.
Left ventricular assisting devices (LVAD)
These are mechanical devices that take over the pumping function of the heart. Their purpose is either to support the patient until his/her heart regains strength or “bridge” the time until heart transplantation can be performed or simply act as a “destination therapy” for patients who cannot have heart transplantation and whose heart no longer has the strength to support their blood circulation.
This is a method by which altering the way the electricity is conducted across the heart can improve the way the heart pumps and help patients with heart failure to have a better quality of life. Resynchronisation therapy usually requires the implantation of a pacemaker through percutaneous or surgical implantation of special wires to the heart. Surgical implantation usually only occurs when there are technical difficulties introducing percutaneous pacing wires, in which case the surgeon will implant the necessary wires via mini sternotomy or using key hole surgery from the side of your chest.
Links:These, like any other published guidelines & evidence, do not and should not override the individual responsibility of healthcare professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and where appropriate and necessary the patient’s guardian or carer.
- The STICH trial: misguided conclusions. Buckberg GD, Athanasuleas CL. J Thorac Cardiovasc Surg. 2009 Nov;138(5):1060-1064
- End-systolic volume following surgical ventricular reconstruction impacts survival in patients with ischaemic dilated cardiomyopathy. Di Donato M, Castelvecchio S, Menicanti L. Eur J Heart Fail. 2010 Apr;12(4):375-81. Epub 2010 Feb 25
- Quality of life and economic outcomes with surgical ventricular reconstruction in ischemic heart failure: results from the Surgical Treatment for Ischemic Heart Failure trial. Mark DB, Knight JD, Velazquez EJ, Howlett JG, Spertus JA, Djokovic LT, Harding TM, Rankin GR, Drew LA, Szygula-Jurkiewicz B, Adlbrecht C, Anstrom KJ; Surgical Treatment for Ischemic Heart Failure (STICH) Trial Investigators. Am Heart J. 2009 May;157(5):837-44, 844.