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Congenital ventricular aneurysms (CVA) are rare cardiac anomalies that have been predominantly described in the Black population. They are characterized by an akinetic ventricular protrusion that is commonly located at the basal and apical segments. Although the diagnosis is often incidental and the majority of patients are asymptomatic, life-threatening events such as persistent ventricular arrhythmias, CVA rupture, and heart failure are not uncommon. However, no standardized therapy is currently available and good outcomes have been reported with both conservative and surgical management. We report the cases of two young Black African patients with huge symptomatic CVA lesions who underwent successful surgical repair with a ventricular restoration technique. Both cases were consulted for chest pain and dyspnea. Chest X-ray and transthoracic Doppler echocardiography suggested the diagnosis. Thoracic angioscanner and thoracic magnetic resonance imaging confirmed the diagnosis. Both patients underwent successful surgery. This case report aims to revisit the diagnostic and therapeutic approach to this rare pathology, in our professional environment., Competing Interests: The authors declare no competing interests., (Copyright: Charles Mve Mvondo et al.)

Background: Less Invasive Ventricular Enhancement (LIVE) with Revivent TC is an innovative therapy for symptomatic ischemic heart failure (HF). It is designed to reconstruct a negatively remodeled left ventricle (LV) after an anterior myocardial infarction (MI) by plication of the scar tissue. Its indications are specific, and as with any other structural heart intervention, the success of the procedure starts with appropriate patient selection. We aim to present the indications of the technique, crucial aspects in patient selection, and individual case planning approach. Methods and results: After clinical evaluation, transthoracic echocardiography is the first imaging modality to be performed in a potential candidate for the therapy. However, definitive indication and detailed case planning rely on late gadolinium‐enhanced cardiac magnetic resonance imaging or multiphasic contrast‐enhanced cardiac computed tomography. These imaging modalities also assist with relative or absolute contra‐indications for the procedure. Individual assessment is done to tailor the procedure to the specifics of the LV anatomy and location of the myocardial scar. Conclusion: LIVE procedure is a unique intervention to treat symptomatic HF and ischemic cardiomyopathy after anterior MI. It is a highly customizable intervention that allows a patient‐tailored approach, based on multimodality imaging assessment and planification. [ABSTRACT FROM AUTHOR]

Resumen: La pérdida de la geometría ventricular es la principal causa de progresión de la insuficiencia cardiaca y de riesgo en la morbimortalidad en pacientes con cardiomiopatía dilatada. La insuficiencia mitral ocurre secundariamente a la dilatación anular, a la geometría ventricular izquierda alterada y a la disfunción del músculo papilar. La cirugía de restauración ventricular (CRV) se introdujo como una opción terapéutica con la hipótesis que mejora el funcionamiento mitral al reducir los volúmenes del ventrículo izquierdo, las distancias de los músculos papilares y restaurar la geometría cardiaca. Este trabajo presenta el caso clínico de una paciente con insuficiencia cardiaca de etiología isquémica necrótica, que fue intervenida quirúrgicamente y se le realizó restauración ventricular, células madre y matriz de colágeno biodegradable. En el seguimiento a los dos años, la paciente no necesito más ingresos por descompensación, se observó que la clase funcional (CF) (NYHA) mejoró de CF III a I. La fracción de eyección del ventrículo izquierdo (FEVI) se incrementó de 20 a 27%, la insuficiencia mitral se redujo de grado IV a II, presentando estudios complementarios con mejora en el ejercicio. Los resultados de este caso sugieren que la técnica de restauración ventricular basada en el modelo de la banda miocárdica se aproxima a la anatomía y fisiología cardiaca normal, corrigiendo la insuficiencia mitral isquémica sin asociar cirugía valvular. Abstract: Loss of ventricular geometry is the main cause of progression of heart failure and risk of mortality in patients with dilated cardiomyopathies. Mitral regurgitation occurs secondary to annular dilatation, altered left ventricular geometry and papillary muscle dysfunction. Ventricular restoration surgery was introduced as a therapeutic option with the hypothesis that improves mitral functioning by reducing left ventricular volumes, papillary muscle distances and restoring cardiac geometry. This work presents a clinical case of a patient with heart failure of necrotic ischemic etiology, who underwent surgery and had ventricular restoration, stem cells and biodegradable collagen matrix. At the two-year follow-up, the patient did not need further hospitalizations due to decompensation, it was observed that the functional class (NYHA) improved from FC III to I. On the other hand, the ejection fraction improved from 20% to 27%, Mitral Insufficiency was reduced from grade IV to grade II presenting complementary studies with improvement in exercise. The results of this case suggest that the miocardial band and the restoration technique based on this model approximate normal cardiac anatomy and physiology, correcting ischemic mitral regurgitation without associating valvular surgery.

The Revivent TC™ Transcatheter Ventricular Enhancement System (BioVentrix Inc.) is intended for use in heart failure with cardiac dysfunction a previous myocardial infarction. The resultant increased left ventricular systolic volume and discrete, contiguous, noncontractile (akinetic and/or dyskinetic) scar located in the anteroseptal, apical (may extend laterally) region of the left ventricle (LV) lends itself to Revivent. The procedure, called Less Invasive Ventricular Enhancement, consists of the implantation of a series of microanchors pairs to exclude the scarred myocardium, to reduce and reshape the LV. We present the procedure step-by-step, as team coordination between the cardiac surgeon and the interventional cardiologist is essential to ensure good procedural outcomes. This is a novel and new technique to address heart failure secondary to myocardial infarction. [ABSTRACT FROM AUTHOR]

Left ventricular (LV) remodeling results in continuous cardiac chamber enlargement and contractile dysfunction, perpetuating the syndrome of heart failure. With current exhaustion of the neurohormonal medical paradigm, surgical and device-based therapies have been increasingly investigated as a way to restore LV chamber architecture and function. Left ventricular restoration has been attempted with surgical procedures, such as partial left ventriculectomy, surgical ventricular restoration with or without revascularization, and devices, such as the Acorn CorCap, the Paracor HeartNet, and the Myocor Myosplint. Whereas all these techniques require surgical access, with or without cardiopulmonary bypass, a newer ventricular partitioning device (VPD) called Parachute, can be delivered percutaneously through the aortic valve. Designed to achieve LV restoration from within the ventricle, this VPD partitions the LV by isolating aneurysmal from normal myocardium thereby diminishing the functioning cavity. This review aims to critically appraise the above methods, with particular attention to device-based therapies. [ABSTRACT FROM AUTHOR]

OBJECTIVES Ventricular constraint devices made of polyester and nitinol have been used to treat heart failure patients. Long-term follow-up has not demonstrated significant benefits, probably due to the lack of effects on myocardial tissue and to the risk of diastolic dysfunction. The goal of this experimental study is to improve ventricular constraint therapy by associating stem cell intrainfarct implantation and a cell-seeded collagen scaffold as an interface between the constraint device and the epicardium. METHODS In a sheep ischaemic model, three study groups were created: Group 1: coronary occlusion without treatment (control group). Group 2: postinfarct ventricular constraint using a polyester device (Acorn CorCap). Group 3: postinfarct treatment with stem cells associated with collagen matrix and the polyester device. Autologous adipose mesenchymal stem cells cultured in hypoxic conditions were injected into the infarct and seeded into the collagen matrix. RESULTS At 3 months, echocardiography showed the limitation of left ventricular end-diastolic volume in animals both treated with constraint devices alone and associated with stem cells/collagen. In Group 3 (stem cell + collagen treatment), significant improvements were found in ejection fraction (EF) and diastolic function evaluated by Doppler-derived mitral deceleration time. In this group, histology showed a reduction of infarct size, with focuses of angiogenesis and minimal fibrosis interface between CorCap and the epicardium due to the interposition of the collagen matrix. CONCLUSIONS Myocardial infarction treated with stem cells associated with a collagen matrix and ventricular constraint device improves systolic and diastolic function, reducing adverse remodelling and fibrosis. The application of bioactive molecules and the recent development of nanobiotechnologies should open the door for the creation of a new semi-degradable ventricular support bioprosthesis, capable of controlled stability or degradation in response to physiological conditions of the left or right heart. [ABSTRACT FROM PUBLISHER]

Background: Surgical ventricular reconstruction (SVR) has been used to control adverse ventricular remodeling and improve cardiac function in ischemic cardiomyopathy. The purpose of this systematic review and meta-analysis was to collect and analyze all available evidence on the utilization and efficacy of SVR., Methods: An electronic database search was performed to identify all retrospective and prospective studies on SVR for ischemic cardiomyopathy in the English literature from 2000 through 2020. A total of 92 articles with a collective 7,685 patients undergoing SVR were included in the final analysis., Results: The mean patient age was 61 years (95% CI: 59-63) and 80% (78-82%) were male. Congestive heart failure was present in 66% (54-78%) and angina in 58% (45-70%). Concomitant coronary artery bypass grafting was undertaken in 92% (90-93%) while 21% (18-24%) underwent mitral valve repair. Pre vs. post-SVR, significant improvement was seen in left ventricular ejection fraction (LVEF) [29.9% (28.8-31.2%) vs. 40.9% (39.4-42.4%), P<0.01], left ventricular end-systolic (LVESD) and end-diastolic diameters (LVEDD) [LVESD: 49.9 mm (48.1-51.7) vs. 45 mm (42.8-47.3), P<0.01, LVEDD: 63.8 mm (62-65.6) vs. 58.23 mm (56.6-60), P<0.01], and left ventricular end-systolic (LVESVI) and end-diastolic volume indices (LVEDVI) [LVESVI: 83.9 mL/m 2 (79.3-88.4) vs. 46.8 mL/m 2 (43.5-50.1), P<0.01; LVEDVI: 119.9 mL/m 2 (112.1-127.6) vs. 79.6 mL/m 2 (73.6-85.7), P<0.01]. Mean New York Heart Association class improved from 3 (2.8-3.1) to 1.8 (1.5-2) (P<0.01). The 30-day mortality was 4% (3-5%) while late mortality was 19% (9-34%) at a mean follow-up of 27.5 [21-34] months., Conclusions: In patients with ischemic cardiomyopathy, SVR reduces left ventricular volumes and improves systolic function leading to symptomatic improvement., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare., (2022 Annals of Cardiothoracic Surgery. All rights reserved.)

Today's healthcare delivery system is challenged with an escalating number of heart failure patients who have exhausted medical therapy and overwhelmed the limits of organ transplantation. Scientific and technological advances over the last 20 years have now brought new surgical options to this vast patient population, ranging from ventricular restoration surgery to surgical gene therapy and beyond. This article reviews the myriad of surgical options that are available to these patients, their benefits and shortcomings, as well as potential future directions. [ABSTRACT FROM AUTHOR]

Abstract: Background: Congestive heart failure (CHF) is the leading cause of hospital admissions in the United States. Methods and Results: CHF has a variety of palliative options for treatment and 1 curative one: cardiac transplantation. Palliative medical therapies are often limited in effectiveness by progression of the disease or patient intolerance. Because of limited donor availability, alternative surgical strategies are now being relied on for palliation of patients in end-stage CHF. Conclusion: In this manuscript, we review the principles, outcomes, and practices of some of these surgical strategies often used in the palliation of end-stage CHF. [Copyright &y& Elsevier]

Anterior myocardial infarction produces abrupt left ventricular (LV) dysynergy and global systolic dysfunction. Rapid intense neurohumoral activation, infarct expansion, and early ventricular chamber dilatation all contribute to restoring a normal stroke volume despite a persistently depressed ejection fraction. Continued neurohumoral activation provokes late remodeling of the remote non-infarcted myocardium, characterized by an abnormal progressively increasing LV volume/mass ratio that leads to further LV remodeling. Heart failure is a progressive disorder of LV remodeling. Heart failure from post-infarction remodeling is unique because of the persistent non-functioning scar that self- perpetuates abnormal loading conditions and neurohumoral activation. Medical therapy attenuates remodeling and improves survival but does not change the size of the scar. Surgical ventricular restoration to exclude the non-functioning infarct from the ventricular cavity decreases ventricular volumes, increases global ejection fraction, attenuates neurohumoral activation and yields an excellent 5-year survival. Combined medical and surgical therapy is recommended in this patient population. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To review outcomes and quality of life following two surgical strategies for severe left ventricular dysfunction due to ischemic dilated cardiomyopathy. Methods: Hospital and follow-up records of 111 patients with extensive ischemic cardiomyopathy (mean age 57.3±8.4) referring to our institution between January 1996 and December 2003 were reviewed. Group A included 42 patients (mean age 62.4±7.9) with morphological and functional cardiac parameters allowing for ventricular restoration (including endoventricular circular patch plasty, coronary artery by-pass grafting, and, when needed, mitral surgery). Group B included 69 patients (mean age 54.3±7.2), undergoing cardiac transplantation. Hospital mortality, treatment-related late mortality, incidence of cardiac events, freedom from cardiac failure, freedom from hospital re-admission, functional recovery at follow-up (3075.2pts/months; 100% complete) and quality of life (WHOQOL test) were assessed. Results: Hospital mortality was 19% in group A and 8.7% in group B (P=0.143). No treatment-related late deaths were observed in group A, while six deaths (9.5%) occurred in group B (P=0.063). Incidence of cardiac events was comparable. At 60 months, freedom from cardiac failure was 93.5±0.04 and 86.2±0.05%, respectively (P=0.23), freedom from hospital re-admission was 93.5±0.04 and 61.3±0.07% (P=0.002). Exertion dyspnea was present in 40% patients in group A versus 13% in group B (P=0.006). WHOQOL test showed a satisfying quality of life in both groups, although patients undergoing restoration reached higher scores in the psychological and social domains. Conclusions: Selected patients with ischemic cardiomyopathy, potentially eligible for transplantation, can be managed by ventricular restoration. In those patients post-operative quality of life is satisfactory, with comparable survival and low risk of re-hospitalization. [Copyright &y& Elsevier]

Abstract: Left ventricular geometry is distorted after anterior infarction caused by occlusion of a wrap around left anterior descending artery. Loss of the apex creates a spherical left ventricular (LV) chamber, whose rebuilding requires reconstruction techniques that exclude the non-functional inferior wall. The described technique of tailoring the apex defines a way to create an oblique elliptical rim for subsequent patch placement to complete the restoration procedure. This method of ventricular rebuilding differs from methods that follow the inferior wall scar, which result in a restoration procedure that leaves a spherical or box-like apical region. [Copyright &y& Elsevier]

A letter to the editor is presented in response to the article "Lessons from a mathematical hypothesismodification of the endoventricular circular patch plasty," by Srilakshmi M. Adhyapak and Venkateswara Rao Parachuri in the 2012 issue.

We report a novel method of surgical ventricular restoration for an infarcted lateral wall: the endocardial linear infarct exclusion technique. First, transmural ventriculotomy is performed at the centre of the scar longitudinally along the coronary artery. Second, the inner layer is sutured in a longitudinal direction with 4-0 polypropylene continuous sutures to approximate the border between the normal and infarcted myocardium. Finally, the outer layer is closed with a combination of interrupted buttress and continuous over-and-over sutures with outer felt reinforcement. The advantages of endocardial linear infarct exclusion technique are as follows: the risk of bleeding is low; it is not technically demanding and is reproducible; the coronary artery can be preserved; approximation of the base of the anterior and posterior papillary muscles is possible in the case of ischaemic mitral regurgitation and it can also be applied to the anterior and inferior walls., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

The article presents a case study of a 58-year old man with congestive heart failure. The patient underwent ventriculography, echocardiography and computed tomography which indicated a large inferoposterior left ventricular aneurysm. Furthermore, a direct linear suture was executed for restoring his left ventricle.

Abstract: Objective: Ventricular restoration is a novel procedure for treating congestive heart failure (CHF). The two important features include a technically correct procedure and adequate myocardial protection. The two protective techniques include conventional cardioplegia and the beating heart. Methods: This report reviews a RESTORE clinical registry and summarizes background experimental work related to myocardial protection in failing dilated hearts. Results: The RESTORE registry is reported, where protection is 55% with cardioplegia and 45% with beating heart. The beating method was used more frequently in patients with ejection fraction <30%, end systolic volume 80ml/m2, NYHA class >III/IV. Overall survival results favored cardioplegia except for the first 30 days, but after matching patients on age, ejection fraction (EF) and NYHA the beating results and cardioplegic results were comparable. Experimental work evaluated the safety of the beating method in failing dilated ventricles under acute conditions. Supplemental coronary perfusion studies in chronically dilated hearts after tachycardia induced cardiomyopathy were analyzed to show that (a) there was vascular remodeling (less flow at the same pressure in failing hearts with cardioplegic, but not beating delivery; (b) in the open state (used during restoration) subendocardial flow increased in the beating heart, and fell after cardioplegia. These studies were done without ischemia. Conclusions: Cardioplegic delivery for protection is ‘time dependent’ (needing ischemic intervals) while beating nourishment is ‘procedure dependent,’ as continuous perfusion is provided throughout the procedure is suggested. The importance of maintaining high perfusion pressure is emphasized. [Copyright &y& Elsevier]

Abstract: Objective: Surgical ventricular restoration (SVR) is a promising modality for treatment of heart failure due to left ventricular systolic dysfunction, particularly that due to ischemic heart disease. The role of MRI in improving diagnosis, operative planning, and follow-up is reviewed to analyze how one examination may define a spectrum of important considerations. Methods: Proper patient selection and optimal surgical planning relies on accurate assessment of measures of ventricular volume, function, and viability, and of the mechanics of the mitral valve apparatus. A complete preoperative imaging evaluation includes assessment of the left ventricular volume (both systolic and diastolic), regional and global systolic function, viability of the target area for surgical exclusion and of the remote myocardium, determination of the adequacy of the remote myocardium remaining after proposed SVR to support circulatory function, and of the mitral annular dilatation and inter papillary muscle spacing, factors which contribute to functional mitral regurgitation. Results: Cardiac magnetic resonance imaging (MRI) allows a complete evaluation of these quantities: the ventricular systolic and diastolic volumes (and hence ejection fraction) are easily assessed reproducibly and accurately; the regional wall motion of the asynergic area and the remote myocardium can be measured by several quantitative means, including with myocardial tagging, and the presence or absence of nonviable, irreversible scar can be detected with gadolinium-based interstitial contrast agents. Furthermore, an accurate measurement of the mitral annular dimensions and the papillary muscle spacing can be easily performed using cardiac MRI, allowing planning of effective therapy for mitral regurgitation. Conclusions: The entire imaging study can be performed in less than 1h, making cardiac MRI a truly useful and comprehensive tool in planning SVR, and for subsequently evaluating results. [Copyright &y& Elsevier]

Abstract: Objective: Dilated cardiomyopathy from many causes results in a change in ventricular geometry, whereby the elliptical chamber becomes more spherical. This may be the unifying geometric concept of heart failure, with similar alteration of spatial configuration in non-ischemic diffuse myocyte disease, ischemic cardiomyopathy with and without scar, and in valvular heart disease. Methods: This change in architecture alters fiber direction and diminishes function, and has been related to alteration of the apical loop of the helical ventricular myocardial band model of cardiac shape. The underlying concept of rebuilding the ventricle by ventricular restoration is suggested to be reconstruction of form, rather than focusing on only the underlying disease. Results: Examples are shown where the Surgical Anterior Ventricular Exclusion (SAVE) or Pacopexy procedure has been successfully applied to each of the above-mentioned diseases, and is suggested for dilated valvular cardiomyopathy. The interaction between rebuilding form and how this procedure restores more normal fiber orientation is discussed, and the possibility of a macroscopic/microscopic marriage between surgically altering the cardiac scaffold by restoration (macro) and cell biology to improve function in a new helical shape is suggested. Conclusions: The implication of these observations is that the surgical objective should become rebuilding ventricular form, rather than restricting restoration procedures to only addressing the disease. [Copyright &y& Elsevier]

Summary: This overview addresses the remarkable efficiency of the mammalian heart as a pump of unique capacity to quickly vary output and ejection velocity and its relation to ventricular geometry, fiber architecture, integrity of collagen scaffold and microvasculature and appropriate electrical activation. The unique functional capacity of the ventricle depends critically on the organization of cardiac muscle fibers in layers of counter-wound helices encircling the ventricular cavity in a pattern that allows a special twisting motion during systole and early diastole, essential to the mechanical efficiency of the normal ventricle to eject and suction venous return. The important contribution of advances in imaging techniques is reviewed, especially magnetic resonance with tagging and tensor analysis to define fiber orientation; these measurements are made without the use of implanted devices that can distort structure and even impair function. The impact of loss of optimal fiber orientation and geometry of the ventricle as a result of diseases that cause heart failure is analyzed, along with the possibility of improvement by carefully planned surgical restoration of ventricular geometry. The very encouraging results yielded by these therapeutic strategies are critically dependent on a clear understanding of the relation of structure and function that our analysis attempts to promote. Simultaneously, there is full acknowledgment of the unanswered questions that are inevitable but equally essential to the continuing search that scientific progress depends on. [Copyright &y& Elsevier]