Congestive heart failure: Treat the disease, not the symptom: Return to normalcy/Part II The experimental approach

doi:10.1016/j.jtcvs.2007.05.053

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Congestive heart failure: Treat the disease, not the symptom

Return to normalcy/Part II—The experimental approach

Gerald D. Buckberg, MD^_*

Department of Surgery, David Geffen School of Medicine at the University of California–Los Angeles, Los Angeles, Calif.

Received for publication May 4, 2007; accepted for publication May 14, 2007.

^_* Address for reprints: Gerald D. Buckberg, MD, David Geffen School of Medicine at UCLA, Department of Surgery, 10833 Le Conte Avenue, 62-258 CHS, Los Angeles, CA 90095. (Email: gbuckberg@mednet.ucla.edu).

The first 300 words of the full text of this article appear below.

The report by Zhang and associates¹ in this issue applies animportant 3-dimensional magnetic resonance imaging (MRI) taggingmethod to demonstrate that altering ventricular geometry byusing the Dor procedure (as they interpreted this operation)in sheep in congestive heart failure increases systolic circumferentialshortening in remote muscle. These experimental changes documentthe clinical improvement in remote muscle function reportedworldwide with left ventricular (LV) restoration.^2,3 Such applicationof advanced imaging methods allows studies to focus on how interventionsimprove function by changing ventricular muscle deformationthat occurs sequentially during the cardiac twisting motion.Furthermore, these regional functional data allow differentiationfrom nonfunctional remote regions that echocardiographic analysisshows are displaced without contracting, together with providinga time course for displaying how global function is affectedby cardiac rebuilding.

Normal and Abnormal Form

The surgical approach to congestive heart failure, like otheroperative objectives, should treat the disease and not the symptomand return structures toward normal shape, as described by others,⁴and this became the title of my 2001 Journal of Thoracic andCardiovascular Surgery editorial.⁵ The geometric disease inischemic dilated cardiomyopathy is the spherical chamber, whichis different than the elliptical or conical normal heart shape(Figure 1). The symptom is the spherical chamber, whereby thenormal helical chamber develops a more circular configurationthat might flatten fiber orientation and alter performance.^6,7

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Figure 1. The left image shows cardiac shape in the normal heart with a conical or elliptical chamber. The right image shows a dilated failing heart with a spherical shape.

Despite imaging advantages, the experimental design of thisstudy has a major flaw because baseline is ascribed to the infarctionstate rather than to the normal heart. The authors held fastto repeated requests to supplement their database with a designthat introduces normality as a reconstructive guideline for. . . [Full Text of this Article]

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