(Circulation. 1999;99:135-142.)
© 1999 American Heart Association, Inc.
Basic Science Reports |
Restraining Infarct Expansion Preserves Left Ventricular Geometry and Function After Acute Anteroapical Infarction
From the Departments of Surgery and Medicine, School of Medicine and Department of Bioengineering, University of Pennsylvania, Philadelphia, Pa.
Correspondence to Dr L. Henry Edmunds, Jr, Department of Surgery, 6 Silverstein, Hospital of the University of Pennsylvania, Philadelphia, PA 19104. E-mail hedmunds{at}mail.med.upenn.edu
Background—Expansion of an acute myocardial infarction predicts progressive left ventricular (LV) dilatation, functional deterioration, and early death. This study tests the hypothesis that restraining expansion of an acute infarction preserves LV geometry and resting function.
Methods and Results—In 23 sheep, snares were placed around the distal left anterior descending and second diagonal coronary arteries. In 12 sheep, infarct deformation was prevented by Marlex mesh placed over the anticipated myocardial infarct. Snared arteries were occluded 10 to 14 days later. Serial hemodynamic measurements and transdiaphragmatic quantitative echocardiograms were obtained up to 8 weeks after anteroapical infarction of 0.23 of LV mass. In sheep with mesh, circulatory hemodynamics, stroke work, and end-systolic elastance return to preinfarction values 1 week after infarction and do not change subsequently. Ventricular volumes and ejection fraction do not change after the first week postinfarction. Control animals develop large anteroapical ventricular aneurysms, increasing LV dilatation, and progressive deterioration in circulatory hemodynamics and ventricular function. At week 8, differences in LV end-diastolic pressure, cardiac output, end-diastolic and end-systolic volumes, ejection fraction, stroke work, and end-systolic elastance are significant (P<0.01) between groups.
Conclusions—Preventing expansion of acute myocardial infarctions preserves LV geometry and function.
Key Words: ventricles • remodeling • myocardial infarction
This article has been cited by other articles:
 |
|
 |
|
  J. J. Pilla, J. H. Gorman III, and R. C. Gorman Theoretic impact of infarct compliance on left ventricular function. Ann. Thorac. Surg., March 1, 2009; 87(3): 803 - 810. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. P. Ryan, K. Matsuzaki, M. Noma, B. M. Jackson, T. J. Eperjesi, T. J. Plappert, M. G. St. John-Sutton, J. H. Gorman III, and R. C. Gorman Dermal Filler Injection: A Novel Approach for Limiting Infarct Expansion Ann. Thorac. Surg., January 1, 2009; 87(1): 148 - 155. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Mukherjee, J. A. Zavadzkas, S. M. Saunders, J. E. McLean, L. B. Jeffords, C. Beck, R. E. Stroud, A. M. Leone, C. N. Koval, W. T. Rivers, et al. Targeted Myocardial Microinjections of a Biocomposite Material Reduces Infarct Expansion in Pigs Ann. Thorac. Surg., October 1, 2008; 86(4): 1268 - 1276. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Beeri, C. Yosefy, J. L. Guerrero, F. Nesta, S. Abedat, M. Chaput, F. del Monte, M. D. Handschumacher, R. Stroud, S. Sullivan, et al. Mitral regurgitation augments post-myocardial infarction remodeling failure of hypertrophic compensation. J. Am. Coll. Cardiol., January 29, 2008; 51(4): 476 - 486. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Blom, J. J. Pilla, J. Arkles, L. Dougherty, L. P. Ryan, J. H. Gorman III, M. A. Acker, and R. C. Gorman Ventricular Restraint Prevents Infarct Expansion and Improves Borderzone Function After Myocardial Infarction: A Study Using Magnetic Resonance Imaging, Three-Dimensional Surface Modeling, and Myocardial Tagging Ann. Thorac. Surg., December 1, 2007; 84(6): 2004 - 2010. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Sakamoto, L. M. Parish, H. Hamamoto, L. P. Ryan, T. J. Eperjesi, T. J. Plappert, B. M. Jackson, M. G. St John-Sutton, J. H. Gorman III, and R. C. Gorman Effect of Reperfusion on Left Ventricular Regional Remodeling Strains After Myocardial Infarction Ann. Thorac. Surg., November 1, 2007; 84(5): 1528 - 1536. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Hung, M. Chaput, J. L. Guerrero, M. D. Handschumacher, L. Papakostas, S. Sullivan, J. Solis, and R. A. Levine Persistent Reduction of Ischemic Mitral Regurgitation by Papillary Muscle Repositioning: Structural Stabilization of the Papillary Muscle Ventricular Wall Complex Circulation, September 11, 2007; 116(11_suppl): I-259 - I-263. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Langer, F. Rodriguez, A. Cheng, S. Ortiz, K. B. Harrington, M. K. Zasio, G. T. Daughters, J. C. Criscione, N. B. Ingels, and D. C. Miller Alterations in Lateral Left Ventricular Wall Transmural Strains During Acute Circumflex and Anterior Descending Coronary Occlusion Ann. Thorac. Surg., July 1, 2007; 84(1): 51 - 60. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. L. Christman and R. J. Lee Biomaterials for the Treatment of Myocardial Infarction J. Am. Coll. Cardiol., September 5, 2006; 48(5): 907 - 913. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Yano, T. Miura, P. Whittaker, T. Miki, J. Sakamoto, Y. Nakamura, Y. Ichikawa, Y. Ikeda, H. Kobayashi, K. Ohori, et al. Macrophage Colony-Stimulating Factor Treatment After Myocardial Infarction Attenuates Left Ventricular Dysfunction by Accelerating Infarct Repair J. Am. Coll. Cardiol., February 7, 2006; 47(3): 626 - 634. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. M. Jackson, L. M. Parish, J. H. Gorman III, Y. Enomoto, H. Sakamoto, T. Plappert, M. G. St. John Sutton, I. Salgo, and R. C. Gorman Borderzone Geometry After Acute Myocardial Infarction: A Three-Dimensional Contrast Enhanced Echocardiographic Study Ann. Thorac. Surg., December 1, 2005; 80(6): 2250 - 2255. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Pilla, A. S. Blom, J. H. Gorman III, D. J. Brockman, J. Affuso, L. M. Parish, H. Sakamoto, B. M. Jackson, M. A. Acker, and R. C. Gorman Early Postinfarction Ventricular Restraint Improves Borderzone Wall Thickening Dynamics During Remodeling Ann. Thorac. Surg., December 1, 2005; 80(6): 2257 - 2262. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. A. Memon, Y. Sawa, N. Fukushima, G. Matsumiya, S. Miyagawa, S. Taketani, S. K. Sakakida, H. Kondoh, A. N. Aleshin, T. Shimizu, et al. Repair of impaired myocardium by means of implantation of engineered autologous myoblast sheets J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): 1333 - 1341. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Levine and E. Schwammenthal Ischemic Mitral Regurgitation on the Threshold of a Solution: From Paradoxes to Unifying Concepts Circulation, August 2, 2005; 112(5): 745 - 758. [Full Text] [PDF]
|
|
|
|
|
|
F. Rodriguez, F. Langer, K. B. Harrington, A. Cheng, G. T. Daughters, J. C. Criscione, N. B. Ingels, and D. C. Miller Alterations in transmural strains adjacent to ischemic myocardium during acute midcircumflex occlusion J. Thorac. Cardiovasc. Surg., April 1, 2005; 129(4): 791 - 803. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Enomoto, J. H. Gorman III, S. L. Moainie, B. M. Jackson, L. M. Parish, T. Plappert, A. Zeeshan, M. G. St. John-Sutton, and R. C. Gorman Early Ventricular Restraint After Myocardial Infarction: Extent of the Wrap Determines the Outcome of Remodeling Ann. Thorac. Surg., March 1, 2005; 79(3): 881 - 887. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Enomoto, J. H. Gorman III, S. L. Moainie, T. S. Guy, B. M. Jackson, L. M. Parish, T. Plappert, A. Zeeshan, M. G. St. John-Sutton, and R. C. Gorman Surgical treatment of ischemic mitral regurgitation might not influence ventricular remodeling J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 504 - 511. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Cirillo, A. Amaducci, F. Brunelli, M. Dalla Tomba, P. Parrella, G. Tasca, G. Troise, and E. Quaini Determinants of postinfarction remodeling affect outcome and left ventricular geometry after surgical treatment of ischemic cardiomyopathy J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1648 - 1656. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. S. Guy IV, S. L. Moainie, J. H. Gorman III, B. M. Jackson, T. Plappert, Y. Enomoto, M. G. St. John-Sutton, L. H. Edmunds Jr, and R. C. Gorman Prevention of ischemic mitral regurgitation does not influence the outcome of remodeling after posterolateral myocardial infarction J. Am. Coll. Cardiol., February 4, 2004; 43(3): 377 - 383. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Gorman III, B. M. Jackson, Y. Enomoto, and R. C. Gorman The effect of regional ischemia on mitral valve annular saddle shape Ann. Thorac. Surg., February 1, 2004; 77(2): 544 - 548. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Gorman III, R. C. Gorman, B. M. Jackson, Y. Enomoto, M. G. St. John-Sutton, and L. H. Edmunds Jr Annuloplasty ring selection for chronic ischemic mitral regurgitation: lessons from the ovine model Ann. Thorac. Surg., November 1, 2003; 76(5): 1556 - 1563. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. J. Villarreal, M. Griffin, J. Omens, W. Dillmann, J. Nguyen, and J. Covell Early Short-Term Treatment With Doxycycline Modulates Postinfarction Left Ventricular Remodeling Circulation, September 23, 2003; 108(12): 1487 - 1492. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Matsubayashi, P. W.M. Fedak, D. A.G. Mickle, R. D. Weisel, T. Ozawa, and R.-K. Li Improved Left Ventricular Aneurysm Repair With Bioengineered Vascular Smooth Muscle Grafts Circulation, September 9, 2003; 108(90101): II-219 - 225. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. M. Jackson, J. H. Gorman III, I. S. Salgo, S. L. Moainie, T. Plappert, M. St. John-Sutton, L. H. Edmunds Jr., and R. C. Gorman Border zone geometry increases wall stress after myocardial infarction: contrast echocardiographic assessment Am J Physiol Heart Circ Physiol, February 1, 2003; 284(2): H475 - H479. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. C. Gorman, J. H. Gorman III, and L. H. Edmunds Jr. Ischemic Mitral Regurgitation Card. Surg. Adult, January 1, 2003; 2(2003): 751 - 769. [Full Text]
|
|
|
|
|
|
B. M. Jackson, J. H. Gorman III, S. L. Moainie, T. S. Guy, N. Narula, J. Narula, M. G. St. John-Sutton, L. H. Edmunds Jr, and R. C. Gorman Extension of borderzone myocardium in postinfarction dilated cardiomyopathy J. Am. Coll. Cardiol., September 18, 2002; 40(6): 1160 - 1167. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. B. Ratcliffe Non-ischemic infarct extension: A new type of infarct enlargement and a potential therapeutic target J. Am. Coll. Cardiol., September 18, 2002; 40(6): 1168 - 1171. [Full Text] [PDF]
|
|
|
|
|
|
S. L. Moainie, T. S. Guy, J. H. Gorman III, T. Plappert, B. M. Jackson, M. G. St. John-Sutton, L. H. Edmunds Jr, and R. C. Gorman Infarct restraint attenuates remodeling and reduces chronic ischemic mitral regurgitation after postero-lateral infarction Ann. Thorac. Surg., August 1, 2002; 74(2): 444 - 449. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Gorman and J. H. Gorman III Cellular myoplasty: What are we really trying to achieve? J. Thorac. Cardiovasc. Surg., March 1, 2002; 123(3): 582 - 583. [Full Text] [PDF]
|
|
|
|
|
|
R. C. Gorman and J. H. Gorman III Cellular myoplasty: what are we really trying to achieve? Ann. Thorac. Surg., January 1, 2002; 73(1): 342 - 343. [Full Text] [PDF]
|
|
|
|
|
|
F. W. Bowen, S. C. Jones, N. Narula, M. G. St. John Sutton, T. Plappert, L. H. Edmunds Jr, and I. M.C. Dixon Restraining acute infarct expansion decreases collagenase activity in borderzone myocardium Ann. Thorac. Surg., December 1, 2001; 72(6): 1950 - 1956. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. W. Bowen, T. Hattori, N. Narula, I. S. Salgo, T. Plappert, M. G. St. John Sutton, and L. H. Edmunds Jr Reappearance of myocytes in ovine infarcts produced by six hours of complete ischemia followed by reperfusion Ann. Thorac. Surg., June 1, 2001; 71(6): 1845 - 1855. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Jain, H. DerSimonian, D. A. Brenner, S. Ngoy, P. Teller, A. S. B. Edge, A. Zawadzka, K. Wetzel, D. B. Sawyer, W. S. Colucci, et al. Cell Therapy Attenuates Deleterious Ventricular Remodeling and Improves Cardiac Performance After Myocardial Infarction Circulation, April 10, 2001; 103(14): 1920 - 1927. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Q.-G. Xia, O. Chung, H. Spitznagel, S. Illner, G. Janichen, B. Rossius, P. Gohlke, and T. Unger Significance of timing of angiotensin AT1 receptor blockade in rats with myocardial infarction-induced heart failure Cardiovasc Res, January 1, 2001; 49(1): 110 - 117. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Edwards, M. S. Marber, S. T. Kelley, R. Malekan, J. H. Gorman III, B. M. Jackson, R. C. Gorman, Y. Suzuki, T. Plappert, D. K. Bogen, et al. Restraining Infarct Expansion Preserves Left Ventricular Geometry and Function After Acute Anteroapical Infarction • Response Circulation, December 21, 1999; 100 (25): e152 - e152. [Full Text] [PDF]
|
|