Clinical/morphological parallels of postoperative left-ventricle remodeling

In recent years integrated surgical treatment with posti-nfarction remodeling of the left ventricle (LV) has been considered as an alternative to heart transplantation. However, according to literature, in 12-25 % of cases the sizes of cardiac chambers and hemodynamics parameters tend to return to their preoperative values and sometimes even exceed them after such surgical interventions. The question of preoperative prognostication of long-term results of surgical treatment remains yet unanswered. The purpose of our study was to retrospectively determine the relationships of myocardial functional morphology with the outcome of surgical treatment of patients with LV postinfarction remodeling, who had undergone complex surgical treatment. 48 patients who had large-focal myocardial infarction and LV systolic dysfunction with end-diastolic quotient (EDQ) of LV exceeding 100 ml/m2 were examined. Depending on long-term results of operative therapy all patients were divided in two groups: the 1st group consisted of 36 patients whose EDQ was lower than the preoperative values while the 2nd group included 12 patients with repeated remodeling, whose EDQ in a year's time reached the preoperative values or even exceeded them. On comparing retrospectively the initial clinical indices we found no significant difference in the preoperative examination data and the range of operative therapy methods. At the same time the signs of myocarditis in combination with apparent fibrosis (parenchymal-stromal ratio 1.6) of LV myocardium are the factors contributing to unfavourable long-term results of surgical treatment of patients suffering from ischemic cardiomyopathy.