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Left ventricular (LV) dilatation occurs after myocardial infarction and leads to heart failure. LV reconstruction or surgical ventricular restoration (SVR) by means of the Dor procedure reduces LV volume and restores normal LV shape. Mitral repair and surgery for ventricular tachycardia are performed as needed. SVR improves LV function and early and long-term results are good in terms of survival and arrhythmia control. International results as well as the experience of the procedure at Karolinska University Hospital are presented and illustrated with a case report.

Patients with severe heart failure due to valvular disease or coronary artery disease often benefit from conventional heart surgery even in the presence of severe left ventricular dysfunction. If a conventional procedure is not possible, left ventricular reconstructive surgery can be of value in selected cases. In cases of idiopathic dilated cardiomyopathy, the Batista procedure can improve left ventricular function, whereas in patients with ischemic cardiomyopathy, with or without left ventricular aneurysm, an endoventricular patch plasty with septal exclusion might be of value. Some patients with dilated cardiomyopathy and severe mitral regurgitation can benefit from a simplified mitral valvuloplasty.

Atrial fibrillation (AF) is a common arrhythmia associated with significant morbidity and increased mortality, partly due to the increased risk of stroke. The maze procedure, introduced by James Cox of the USA, is an internationally established surgical alternative in cases of unsuccessful medical or catheterised treatment of paroxysmal or chronic AF. It is an open heart procedure, involving multiple transmural incisions and continuous suture lines in both atria. By creating a maze of atrial tissue, the re-entrant circuits causing the AF are interrupted, hence re-establishing regular sinus rhythm and atrioventricular synchronization. The article reviews the initial 3-year experience of the procedure in 10 patients with AF, either paroxysmal (n = 5) or chronic (n = 5). The indications for surgery were disabling symptoms in all 10 cases, medical treatment failure in nine cases, previous AF-associated stroke in three cases, and a significant atrial septal defect in one case. All patients underwent extensive investigation both pre- and post-operatively. Postoperatively, nine of the 10 patients manifested regular sinus or atrial rhythm and freedom from or amelioration of preoperative symptoms associated with AF. There were no deaths, neurological complications or long-term recurrence of arrhythmia. One patient had an early recurrence of AF that was not amenable to medical treatment, and was subsequently treated with His' bundle ablation. Of the remaining nine patients, seven manifested signs of some postoperative atrial contraction at echocardiography, the occurrence of which needs to be borne in mind with a view to reducing the risk of future thromboembolic events. We recommend the maze procedure as an attractive surgical option in cases of unsuccessful medical treatment of paroxysmal or chronic AF.