Infarct Restraint to Limit Adverse Ventricular Remodeling
Infarct Restraint to Limit Adverse Ventricular Remodeling
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DOI：
10.1007/s12265-010-9244-0
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发表时间：
2011-02-01
影响因子：
3.4
通讯作者：
Gorman, Joseph H.
中科院分区：
文献类型：
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作者：
Gorman, Robert C.;Jackson, Benjamin M.;Gorman, Joseph H.
左心室对心肌梗死的反应是一个复杂的生物力学过程，人们对它的了解才刚刚开始。梗死扩张（拉伸）是一种即时的进行性现象，已知可引发并维持心室扩张和整体收缩功能丧失，从而导致症状性心力衰竭。因此，限制梗死扩展已被确定为一个潜在的治疗目标，可以降低与不良梗死诱导的心室重构和由此导致的症状性心力衰竭相关的发病率和成本。这篇综述将展示实验工作，证明梗死扩张对重构过程的核心重要性，以及建立早期机械梗死抑制对限制心肌梗死（MI）后心室重构的有效性的概念验证研究。我们将讨论心肌梗死后早期使用聚合物网状材料（包裹）进行心室约束。支持使用注射脱细胞生物材料来改变梗死材料特性（刚度）和几何形状（厚度）的数据也将被提出。这种方法在我们的实验室和其他实验室中被证明在限制梗死后重构方面是有效的，并且代表了通过微创导管技术限制心肌梗死后早期梗死扩展的潜在手段。
The left ventricular response to a myocardial infarction is a complex biomechanical process that is only beginning to be understood. Infarct expansion (stretching) is an immediate and progressive phenomenon that is known to initiate and sustain the ventricular dilatation and global loss of contractile function that leads to symptomatic heart failure. Limitation of infarct expansion has, therefore, been identified as a potential therapeutic goal that could reduce the morbidity and cost associated with adverse infarction-induced ventricular remodeling and the symptomatic heart failure that results from it. This review will present experimental work that demonstrates the central importance of infarct expansion to the remodeling process as well as proof-of-concept studies that establish the efficacy of early mechanical infarct restraint for limiting ventricular remodeling after myocardial infarction (MI). Ventricular restraint with polymeric mesh materials (wraps) placed early after MI will be discussed. Data supporting the use of injected acellular biomaterials to alter infarct material properties (stiffness) and geometry (thickness) will also be presented. This approach has been shown to be effective in our laboratory and others in limiting post-infarction remodeling and represents a potential means for limiting infarct expansion early after MI via minimally invasive catheter-based technology.