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Ann Thorac Surg 2007;84:1279-1287
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Down-Regulation of Apoptosis After Left Ventricular Aneurysm Repair

^a Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
^b National Yang-Ming University, Institute of Clinical Medicine, Taipei, Taiwan
^c Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan

Accepted for publication April 3, 2007.

^_* Address correspondence to Dr Shih, Division of Cardiovascular Surgery, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan (Email: ccshih{at}vghtpe.gov.tw).

Background: Apoptosis is a common feature of the cardiomyopathic process contriuting to progressive decline in ventricular function after transmural myocardial infarction. We hypothesized that left ventricular aneurysm repair (LVAR) down-regulates apoptotic potential of cardiomyocytes in the surviving myocardium.

Methods: In the rat infarct model, LV aneurysms were repaired by pursestring suture 2 weeks after coronary artery ligation. Cardiac function and myocardial infarction size were assessed by echocardiography and transverse heart sections, respectively, before sacrifice 12 weeks later. Cardiomyocytes and TdT-mediated dUTP terminal nick-end labeling (TUNEL) assays of apoptotic nuclei were analyzed adjacent to and remote from the aneurysm (8 in infarction group, 7 in aneurysm group, and 11 in repair group). Biochemical samples for immunoblot were also obtained from surviving myocardium.

Results: A statistically significant increase in apoptotic rate was seen in both adjacent and remote areas (p < 0.01) after aneurysm formation. After LVAR, heart function was improved, and TUNEL assays also show significant decrease when compared with aneurysm group. But significant decreases were noted only in activated caspase-9 and increases in Bcl-2 in immunoblot analysis when comparing repair group with aneurysm group.

Conclusions: Down-regulation of apoptosis accounts for the change in the long-term benefit after LVAR. To prevent heart failure, LVAR is indicated when it is large enough, and the infarction area should be excluded as much as possible.

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Invited commentary

Hans Joachim Geissler
Ann. Thorac. Surg. 2007 84: 1287. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				C.-P. Hsu, C.-Y. Huang, J.-S. Wang, P.-C. Sun, and C.-C. Shih Extracellular Matrix Remodeling Attenuated After Experimental Postinfarct Left Ventricular Aneurysm Repair Ann. Thorac. Surg., October 1, 2008; 86(4): 1243 - 1249. [Abstract] [Full Text] [PDF]

				H. J. Geissler Invited commentary Ann. Thorac. Surg., October 1, 2007; 84(4): 1287 - 1287. [Full Text] [PDF]