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Left Ventricular Reconstruction

Revascularization and valve operations improve many patients, but in others, ventricular dilation and dysfunction are so severe that direct ventricular surgery is needed to optimize cardiac function. Patients who have a transmural myocardial infarction may develop ventricular dilation and remodeling that lead to changes in increased LV wall stress and LV dysfunction (see  Table 25-2).[38]A host of adverse events are initiated, including increased myocardial oxygen consumption secondary to increased wall stress, increased neurohormone and cytokine levels, afterload mismatch, and subendocardial hypoperfusion. The goals of ventricular reconstruction are to remove or to exclude the infarcted segment to restore an elliptical ventricular chamber, to diminish remote wall stress, to promote helical fiber orientation and to increase thickening of the akinetic or dyskinetic portion of the chamber, to reduce end-systolic volume, to diminish mitral insufficiency, and to …