Điều này cải thiện chức năng toàn cầu và các vụ bắt giữ tiến triển của suy thất trái. Dysrhythmias tâm thất và trào ngược van hai lá được giải quyết trong cùng một thủ tục. Trong các thủ tục Dor, hoặc sửa đổi Buckberg, tâm thất trái được mở thông qua các vết sẹo và endocardectomy tổng phụ (hình ), được thực hiện trên vách ngăn và sau wall | NON-TRANSPLANTSURGER YFOR HEARTFAILURE 71 Figure . Left ventricular restoration by endoventricular patch repair the Dor proCedure as opposed to simple linear aneurysmectomy. Figure . The Dor procedure restores an elliptical shape from the globular failing left ventricle courtesy of Dr Vincent Dor . cavity volume. This improves global function and arrests progression of left ventricular failure. Ventricular dysrhythmias and mitral regurgitation are addressed during the same procedure. In the Dor procedure or the Buckberg modi cation the left ventricle is opened through scar and subtotal endocardectomy g performed over the septum and posterior In the event of recurrent ventricular arrhythmias cryotherapy is applied at the limits of the resection. The boundary between normal endocardium and scar is de ned and a circumferential endoventricular Fontan circular suture passed between 1 2 cm outside the limit of healthy muscle. This circular constricting suture is tied to reduce the size of the left ventricle around a balloon inflated within the cavity to a diastolic volume of 50 70 ml m2. The residual apical defect is then closed with a Dacron patch cut according to the circumference of the circular suture after removing the balloon. The technique restores an elliptical shape fig with improved function over the globular failing ventricle. Intraoperative echocardiography has shown a decrease in LVEDV from a mean of 194 ml to 128 ml p and an improvement in LVEF from a mean of 29 to 41 p .The operation can be performed in patients with very low LVEF 20 and pulmonary hypertension with a hospital mortality of 12 18 . This compares with a 3 mortality for those with ejection fraction 30 . Most patients improve to NYHA I or II but 10 of survivors are not improved and about 25 have persistently raised pulmonary artery pressure through impaired diastolic compliance. Linear left ventricular aneurysm resection and the Dor procedure both improve .
