Oh Mr. Ludwig, you left us with Mrs. Cross as a sub! Well she's pretty funny and easy going, but that was not the highlight of my 2nd hour on Friday. It was actually the movie dealing with heart reduction! I never really watch the videos I listen to them and get the information I need to know, but this one actually got me hooked! It was somewhere between a scary movie and a sci-fi film. My first initial thought was that this was going to be a boring movie, but once I started seeing Batista and the other doctors cut into these people it kinda thrilled me! The gorey sight of it all was a bit overwhelming, but once getting passed that and looking into the real science of it all, it's actually pretty dang interesting. I couldn't believe that Batista was performing these heart surgeries at random. But overall I guess it wasn't that big of a deal considering that in Brazil the laws of Medical Care are not as strict as the United States, but the thought of it is still scary none the less. I was actually really surprised that doctors in the U.S. adopted this style to experiment with. Although when the movie came to an end, there was one other doctor not including Batista that had performed this heart reduction procedure and out of 50 people operated on 3 resulted in death and 12 had no change. However the plus side to that was that 35 of the other patients did get better and showed great results!
Overview of a Heart Reduction
Objectives:
The efficiency of heart reduction surgery is very obsolete. The outcomes can be negative or positive depending on the improvements of the ejection fraction, decreased filling pressure, and the overall size of the heart. If these situations do not function or for fill what was thought to be done the ultimate result is heart failure. The impact on the cardiac mechanics of this type of operation is seemingly unknown.
Methods:
In most heart reduction procedures the left ventricle is divided into two functional compartments. This stimulates excisions in part of the wall. Multiple increments of mass reduction are made to the end-systolic elastance, ejection fraction, stroke volume, end-diastolic pressure and volume, and diastolic stiffness. These changes are what is hoped to better the heart, and avoid heart failure. However the heart can only take so much at a time and this procedure has to be quickly and accurately.
Results:
Changes in systolic function can be accompanied by changes in diastolic function. Although this seems to be a great outcome consequently, overall pump function can falter and be depressed. The geometric rearrangement associated with this operation leads to a reduction in wall stress for a given level of pressure. Which leads to an increase in the efficiency with which wall stress is transduced into intraventricular pressure.
Conclusion:
Overall the pump function in the heart is depressed in the short run after most initial heart reduction surgeries. However, heart reduction my also have beneficial long term implications as well. Also the change in width of ventricles during heart reduction surgery is what implies most changes and are observable through pharmacologic therapy.
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