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 patc h reconstructive repairs on left ventricular dynamics after damages of myocardial infarction, aneurysmal dilatation, and compensatory hypert rophy. 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 myocardiu m resection created a smaller ventricular cavity and, thus, decreased SV Similarly, dV/dP by direct closure is markedly in each of these thr ee transitional stages. In comparison, for the patch repair techniques , SV after augmentation by skeletal muscle ventriculoplasty offered th e most immediate recovery after acute apical infarct with relatively l ittle change in dV/dP Synthetic patch repair after aneurysmal and/or h ypertrophy 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 an d minimizing the negative impact in dV/dP Computer simulation models h ave been extensively used to predict the impact of various operative r epair on ventricular compliance and stroke volume. These techniques al low detailed evaluation of newer or experimental reconstructive surgic al procedures such as skeletal muscle ventriculoplasty.