The structure and function of the helical heart and its buttress wrapping. VI. Geometric concepts of heart failure and use for structural correction.

The macroscopic basis for congestive heart failure is defined as conversion of a helical heart, whereby the apical loop fiber angle orientation that produces a 60% ejection fraction becomes more transverse to develop a spheric configuration. The geometric consequence is flattening of the apical loop architecture, so that the 15% shortening can produce only 30% ejection fraction. The fundamental shape change is alteration of normal relationships between the transverse basal loop and oblique apical loop, to make the apical loop become more basal through more transverse fiber orientation. These fundamental architectural changes are then used to evolve new procedures that restore a more normal, helical, ventricular architecture in ischemic and dilated cardiomyopathy. Direct intraoperative ventricular methods underlie surgical ventricular restoration or endoventricular surgical patch plasty procedures, the Batista procedure, and Pacopexy. These intraventricular objectives are then compared with external approaches without ventriculotomy (ie, reimplantation of cells, pericardial sleeve (acorn), surface radiofrequency ablation, and the myocor approaches). A survey of current direct ventricular clinical results that improve the underlying nondamaged muscle (ie, remote segment) is defined, and related to timing of procedures directed at rebuilding more normal ventricular shape before irreversible collagen and fibrosis develop. The overall intent is to convert the spheric heart into an elliptic configuration. Novel concepts are introduced to suggest an internal ventricular patch can be used as an intercavitary curtain, through covering nonscarred septal muscle (ie, normal but distended) to amplify left ventricular function through producing a more helical structure.