Improvement of Left Ventricular Function after Modified Surgical Ventricular Restoration: Good, Better, Best

Background: The techniques of surgical reconstruction of the left ventricle after an anterior myocardial infarction have evolved toward an increasingly physiologic restoration of ventricular shape and volume, with increasing attention being paid to the multilayered structure of myocardial fibers. Methods: We describe the case of a patient who underwent operation with a new technique of endoventricular patch restoration surgery, which was aimed at rebuilding the physiologic shape and volume of the left ventricle, with special care taken to realign the orientation of myocardial fibers at the site of the surgical suture on the patch. The case was studied preoperatively and postoperatively via a complete echocardiographic assessment, included 2-dimensional speckle tracking imaging for the study of apical rotation and ventricular torsion. Results: All geometric and functional parameters were improved at the early and late postoperative evaluations. The left ventricular shape, diameters, and volumes were restored to near-normal values. Apical rotation was improved, both immediately after the surgical procedure and at the late follow-up, with the normal systolic counterclockwise movement and the small clockwise rotation during isovolumic contraction having been restored-signs of normal fiber disposition. As a consequence, torsion of the ventricle was restored, given that the basal rotation remained the same as before the operation. Conclusions: The beneficial restoration of apical rotation and left ventricular torsion is indirect evidence that our new technique can effectively realign myocardial fibers in a near-normal setting and thereby optimize all aspects of left ventricular performance.