Ann Thorac Surg 2002;73:1507-1513
© 2002 The Society of Thoracic Surgeons
a Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil
b Department of Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
c Department of Internal Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
Accepted for publication October 17, 2001.
* Address reprint requests to Dr Tucci, Department of Physiology, Universidade Federal de São Paulo, Rua Estado de Israel, 181, 94, CEP: 04022-000, São Paulo, Brazil
Backgund. The immediate effects of surgical reduction of left ventricle cavity on cardiac mechanics have not been well defined.
Methods. Cardiac mechanics were analyzed before and after myocardial infarction scar plication in 11 isolated infarcted rat hearts.
Results. Despite a decrease in myocardial stiffness, an increase in chamber stiffness was noted after myocardial infarction scar plication. Systolic function was favored in more than one way. For the same diastolic pressures, maximal developed pressures were higher after myocardial infarction scar plication, and the slope of the systolic pressure-volume relationship was steeper afterwards as compared with before; this means that Frank-Starling recruitment is accentuated in smaller cavities. In addition, the developed net forces needed to generate these pressures were clearly lower afterward than before, indicating reduced ventricular afterload.
Conclusions. The study results show that diastolic function is harmed and systolic function is favored by myocardial infarction scar plication. We suggest that preoperative evaluation of the degree of diastolic dysfunction and impairment of the Frank-Starling mechanism may help to identify patients who may have a poor postoperative outcome due to diastolic or systolic dysfunction.
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