Surgical Reconstruction and Muscular Augmentation of Ventricular Repairs - Their Impact on Compliance and Stroke Volume by Computer-Simulations

Computer simulation techniques were used to explore direct versus patch reconstructive repairs on left ventricular dynamics after damages of myocardial infarction, aneurysmal dilatation, and compensatory hypertrophy. This ellipsoid geometric modeling allowed further assessment of these three pathological stages on left ventricular compliance (dV/dP) and stroke volume (SV). Primary surgical closure after any myocardium resection created a smaller ventricular cavity and, thus, decreased SV Similarly, dV/dP by direct closure is markedly in each of these three transitional stages. In comparison, for the patch repair techniques, SV after augmentation by skeletal muscle ventriculoplasty offered the most immediate recovery after acute apical infarct with relatively little change in dV/dP Synthetic patch repair after aneurysmal and/or hypertrophy formation preserved the best SV despite negative shifts in dV/dP Therefore, maintaining geometric shape and retaining functional continuity are important operative considerations for optimizing SV and minimizing the negative impact in dV/dP Computer simulation models have been extensively used to predict the impact of various operative repair on ventricular compliance and stroke volume. These techniques allow detailed evaluation of newer or experimental reconstructive surgical procedures such as skeletal muscle ventriculoplasty.