Abstract
Partial left ventriculectomy (PLV)constitutes a new surgical procedure that is postulated to improve cardiac pump function in patients with end-stage heart failure. PLV is undergoing trials in a number of clinics with, thus far, disappointing rates of success. It remains to be seen whether PLV works, and if so how. Consequently, a number of basic questions have been raised. Three of these will be addressed in this report: (1) can a reason be identified to explain why the heart enlarges progressively as its failure becomes gradually more severe; (2) should final selection of patients, considered for PLV, be based on the remaining (left) ventricular contractile properties as estimated from the ventricle's pressure–volume diagram; and (3) if this popular method of estimation is found to be deficient, can a new approach be designed? It is concluded that (1) ventricular enlargement requires less wall muscle shortening to produce a normal stroke volume, suggesting that enlargement is nature's way to facilitate pumping by an impaired contractile mechanism, (2) the contractile properties play a role in defining the pressure–volume (work) loop, but they are not retrievable, and (3) a different methodology is developed to estimate contractile properties continuously for the entire heart cycle.
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