Cheng W, Justicz A G, Soberman M S, Alazraki N P, Santamore W P, Sink J D
Department of Cardiothoracic Surgery, Philadelphia Heart Institute, Presbyterian Medical Center, PA 19104.
J Thorac Cardiovasc Surg. 1992 Jun;103(6):1207-13.
The effects of cardiomyoplasty were evaluated with multiple-gated equilibrium radionuclide angiocardiography and catheterization in a canine model of chronic heart failure. Doxorubicin was administered to 12 dogs at a dose of 1 mg/kg/wk intravenously for 10 weeks. Left ventricular ejection fraction was reduced from a mean of 53.6% +/- 3.4% to 33.5% +/- 2.3% preoperatively. Two dogs died of presumed arrhythmia during this period. Cardiomyoplasty with the left latissimus dorsi muscle was performed on 10 dogs. The muscle was wrapped around both the left and right ventricles. Five dogs died of infection or arrhythmia after the operation. Postoperatively the muscle remained unstimulated for 2 weeks to allow adhesion to the heart. After this period, the latissimus dorsi muscle was conditioned by a progressive stimulation protocol. After the muscle was conditioned, multiple-gated equilibrium radionuclide angiocardiography studies showed that left ventricular global ejection fraction was 18.4% +/- 7.2% at 0 volts (nonstimulation), 26.2% +/- 3.7% at 5-volt stimulation (p less than 0.05), and 31.0% +/- 5.4% at 10-volt stimulation (p less than 0.05). Regional ejection fractions in low lateral, apical, and low septal regions at 5 volts and 10 volts were higher than those at 0 volts (p less than 0.05). Regional wall motion (percent radial shortening) of the low lateral region was higher than that during nonstimulation (p less than 0.05). Peak emptying rate was 2.07 +/- 0.95 end-diastolic counts per second at 0-volt, 3.10 +/- 0.67 at 5-volt, and 3.34 +/- 0.89 at 10-volt stimulation (p less than 0.05). Peak filling rate was 1.81 +/- 0.52 end-diastolic counts per second at 0-volt, 2.67 +/- 1.18 at 5-volt, and 3.11 +/- 0.65 at 10-volt stimulation (p less than 0.05). Cardiac catheterization data showed a nonsignificant increase in left ventricular rate of pressure rise with increasing voltage (1302 +/- 355 mm Hg/sec at 0 volts, 1450 +/- 413 mm Hg/sec at 5 volts, and 1568 +/- 455 mm Hg/sec at 10 volts). Left ventricular systolic pressures were unchanged. End-diastolic pressures decreased (11.2 +/- 1.48 mm Hg at 0 volts, 10.4 +/- 2.30 mm Hg at 5 volts, and 9.6 +/- 1.52 at 10 volts; p less than 0.05). These data show that cardiomyoplasty can improve indices of systolic and diastolic function in a canine model of chronic heart failure.
在慢性心力衰竭犬模型中，采用多门控平衡放射性核素血管造影术和心导管检查法评估心肌成形术的效果。给12只犬静脉注射阿霉素，剂量为1毫克/千克/周，持续10周。术前左心室射血分数从平均53.6%±3.4%降至33.5%±2.3%。在此期间，2只犬死于推测的心律失常。对10只犬进行背阔肌心肌成形术。将肌肉包绕在左、右心室周围。5只犬术后死于感染或心律失常。术后肌肉在2周内不进行刺激，以使肌肉与心脏粘连。在此期间过后，通过逐步刺激方案对背阔肌进行训练。在肌肉训练后，多门控平衡放射性核素血管造影术研究显示，左心室整体射血分数在0伏（无刺激）时为18.4%±7.2%，在5伏刺激时为26.2%±3.7%（p<0.05），在10伏刺激时为31.0%±5.4%（p<0.05）。在5伏和10伏时，下外侧、心尖和下间隔区域的局部射血分数高于0伏时（p<0.05）。下外侧区域的局部室壁运动（径向缩短百分比）高于无刺激时（p<0.05）。峰值排空率在0伏时为2.07±0.95个舒张末期计数/秒，在5伏时为3.10±0.67，在10伏刺激时为3.34±0.89（p<0.05）。峰值充盈率在0伏时为1.81±0.52个舒张末期计数/秒，在5伏时为2.67±1.18，在10伏刺激时为3.11±0.65（p<0.05）。心导管检查数据显示，随着电压升高，左心室压力上升速率无显著增加（0伏时为1302±355毫米汞柱/秒，5伏时为1450±413毫米汞柱/秒，10伏时为1568±455毫米汞柱/秒）。左心室收缩压无变化。舒张末期压力降低（0伏时为11.2±1.48毫米汞柱，5伏时为10.4±2.30毫米汞柱，10伏时为9.6±1.52；p<0.05）。这些数据表明，在慢性心力衰竭犬模型中，心肌成形术可改善收缩和舒张功能指标。
