Endocardial excision versus encircling endocardial ventriculotomy. A comparison of effects on ventricular structure and function.

Although endocardial excision and encircling endocardial ventriculotomy are being performed in patients with extensive triple-vessel disease and compromised ventricular function, long-term effects of the operative intervention on structure and function of the left ventricle have not been determined. These procedures were performed in healthy dogs in three groups: control (ventriculotomy alone), endocardial excision, and encircling endocardial ventriculotomy (five dogs per group). Six weeks later, through a left thoracotomy, an arterial line, left atrial line, and Swan-Ganz catheter were inserted. Cardiac output measurements permitted calculation of left ventricular stroke work index, and gated nuclear ventriculograms permitted calculation of left ventricular volume indices. Myocardial performance (stroke work index/end-diastolic volume index relation), systolic elastance (systolic blood pressure/end-systolic volume index relation) and diastolic pressure-volume relationship (left atrial pressure/end-diastolic volume index relation) were determined from volume loading studies. In the endocardial excision group, the left atrial pressures were increased at similar end-diastolic volumes (p less than 0.05 by performance and systolic elastance were similar in the three groups. On completion of hemodynamic studies, the hearts were excised. Gross and light microscopic examination showed that the inner layer of myocardium was scarred in the area of intervention after both endocardial excision and encircling endocardial ventriculotomy. In neither group was there significant morphologic change elsewhere in the myocardium. Both endocardial excision and encircling endocardial ventriculotomy have little effect on long-term structure and function when performed in healthy canine hearts.