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J Thorac Cardiovasc Surg. 2010 Jul;140(1):233-9, 239.e1-4. doi: 10.1016/j.jtcvs.2009.11.055. Epub 2010 Mar 17.

Dor procedure for dyskinetic anteroapical myocardial infarction fails to improve contractility in the border zone.

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  • 1Department of Surgery, University of California, San Francisco, Calif, USA.

Abstract

BACKGROUND:

Endoventricular patch plasty (Dor) is used to reduce left ventricular volume after myocardial infarction and subsequent left ventricular remodeling.

METHODS AND RESULTS:

End-diastolic and end-systolic pressure-volume and Starling relationships were measured, and magnetic resonance images with noninvasive tags were used to calculate 3-dimensional myocardial strain in 6 sheep 2 weeks before and 2 and 6 weeks after the Dor procedure. These experimental results were previously reported. The imaging data from 1 sheep were incomplete. Animal specific finite element models were created from the remaining 5 animals using magnetic resonance images and left ventricular pressure obtained at early diastolic filling. Finite element models were optimized with 3-dimensional strain and used to determine systolic material properties, T(max,skinned-fiber), and diastolic and systolic stress in remote myocardium and border zone. Six weeks after the Dor procedure, end-diastolic and end-systolic stress in the border zone were substantially reduced. However, although there was a slight increase in T(max,skinned-fiber) in the border zone near the myocardial infarction at 6 weeks, the change was not significant.

CONCLUSIONS:

The Dor procedure decreases end-diastolic and end-systolic stress but fails to improve contractility in the infarct border zone. Future work should focus on measures that will enhance border zone function alone or in combination with surgical remodeling.

Published by Mosby, Inc.

PMID:
20299030
[PubMed - indexed for MEDLINE]
PMCID:
PMC2907919
Free PMC Article
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