Aims: The present study investigates the geometry of failing left ventricles with a special focus on apical deformation. A new surgical remodelling technique is evaluated. Methods: In 124 patients with impaired left ventricular function undergoing CABG the geometry of the left ventricle (LV) was evaluated by MRI scanning. Besides the conventional sphericity index SI two further indices were calculated, a length index (LV lengthsyst/LV lengthdiast) and an apical conicity index (apical axis/short axis). The results were compared to 15 patients with CHD and normal LV function and 10 test persons. Perpendicular apical compression stitches were placed in 35 patients; a second MRI was performed to compare the remodelling to preoperative geometry and to patients without remodelling. Results: In failing left ventricles LV length increased (5.3±0.6cm/m2 vs. 4.7±0.8cm/m2 in control patients and 4.6±0.3cm/m2 in test persons). Longitudinal shortening was also elevated (0.94±0.04 versus 0.78±0.06 and 0.81±0.07). The classical systolic SI was 0.56±0.06 in heart failure patients, 0.50±0.05 in control patients and 0.48±0.04 in test persons. The apical conicity indices were 0.71±0.08, 0.59±0.07 and 0.58±0.06 respectively, thus the deformation was more pronounced at the apex. A significant remodelling was achieved in the apical stitch patients. The length index improved to 0.85±0.1, the apical index to 0.62±0.06. Conclusions: Besides global dilatation failing left ventricles in CHD patients demonstrated elongation and reduction in longitudinal contractility as well as pronounced apical dilatation with spherical deformation. An apical remodelling stitch was able to normalize ventricular geometry.