ABSTRACT
Coronary revascularization is obviously the first logical indication if some part of the diseased myocardium remains ischemic. The revascularization can be conducted by endoluminal or surgical approach according to the type, size, and number of coronary stenosis or occlusions. Heart transplantation remains in 2004 the only surgical curative radical technique of end-stage ischemic cardiomyopathy with permanent intractable congestive heart failure. Cardiac magnetic resonance imaging can easily demonstrate the presence of subendocardial scar by the use of gadolinium late enhancement, which shows the necrotic region surrounded by normal muscle. The dilatation increases left ventricular stroke volume and temporarily improves the cardiac index. The neurohormonal hypothesis postulates that neurohormones initially serve an adaptive role by maintaining cardiac output and tissue perfusion, but in the later stages the responses become pathological and contribute to adverse remodeling and progressive ventricular failure. Mitral insufficiency is commonly associated with left ventricular scar, and the mitral valve must be assessed carefully and during surgery using transesophageal echocardiography.
