Percutaneous ventricular restoration in a chronic heart failure patient

Introduction Heart failure is one of the major unsolved problems in cardiology and one of the most prevalent causes of death. The most important cause of heart failure is coronary heart disease. Within a few years after a myocardial infarction, approximately 20-50% of the patients develop heart failure1,2. Medical and surgical treatment both have major limitations. Heart failure patients with clinical manifestation as assessed by the ACC/AHA, NYHA classification show a two-year-mortality rate for class I patients of 10%, class II patients of 20%, class III patients of 30 to 40% and class IV patients a two-year-mortality rate of up to 50%. Heart failure is more common in patients with an anterior infarction3. This is due to the amount of myocardium affected and also due to the curved geometry and thinner nature of the apex. The associated remodelling and wall stress produce an inefficient and often failing left ventricle. Fifty seven percent of patients with an anterior infarction develop heart failure one year after thrombolytic therapy for an acute MI4. Heart failure after myocardial infarction (MI) is a progressive disease5. There have been many advances in medical treatment the last two decades with the addition of beta-blockers, ACE-inhibitors and angiotensin-receptor-blockers but the incidence of morbidity and mortality for post-MI patients continues to be excessive6,7. However, these regimens have certain limitations, especially when a left ventricular antero-apical aneurysm is present. Surgical aneurysm resection has evolved over the last 50 years. It has included closure of the left ventricle either directly (linear closure first reported by Cooley8), by implantation of a patch or by using the Batista method9. However, favourable outcomes have only been reported in selected patients because of high morbidity and mortality rates10. A novel implantable device has been developed to treat patients with left ventricular dysfunction and apical wall motion abnormalities. It may deter progressive ventricular remodelling by partially isolating the dysfunctional region. Isolation is achieved by implanting an umbrella-like membrane, the Ventricular Partitioning Device (VPD) within the left ventricle apex. The hypothesis is to decrease both chamber volumes and myocardial stress while improving haemodynamics. (Figures 1 a and b) This report features our first implantation of this new implantable device in a 70-year-old male patient. The procedure was successful without complications. His one month follow-up revealed his clinical status to be stable.