Surgical remodeling of left ventricle.

In the future, we can certainly expect better assessment of myocardial wall, LV morphology, and performance, with careful approach and analysis of CMR allowing us to check exactly the morphology and volume performances of the LV, and chiefly the wall itself (Fig. 6). Perhaps it will be possible to have a hope of recovery for dilated but nonscarred myocardium, through a combination of currently existing surgical treatment (LVR + myocardial revascularization + mitral repair) and new techniques such as LVAD in appraisal, to help the nondiseased and tired myocardium, and suppress the immune or the autogenous hormonal reaction and let antagonist drugs be efficient. Analysis of some results published by the Berlin Heart Center in Berlin, Germany and others from Magdi Yacoub, MD (personal communication, 2002) showed improvement in LV wall thickness and contraction after months of left ventricular assistance, allowing weaning the idiopathic cardiomyopathy patient from assistance (bridge to recovery). Similar management may be possible in ischemic cardiomyopathy, where the LV wall is not uniformly diseased--one part is a scar and one part is dilated with living perfused myocardium. The synthesis of surgery (LVR) for the scarred area and medical treatment and mechanical support for the dilated portion can become the future method to treat severe end-stage ischemic congestive heart failure. The potential of adding cellular therapy to stimulate growth in the viable distended myocardium is perhaps a further promising complement of this treatment.