Zhang Peng, Guccione Julius M, Nicholas Susan I, Walker Joseph C, Crawford Philip C, Shamal Amin, Saloner David A, Wallace Arthur W, Ratcliffe Mark B
Department of Surgery, University of California, San Francisco, Calif, USA.
J Thorac Cardiovasc Surg. 2005 Oct;130(4):1032-8. doi: 10.1016/j.jtcvs.2005.05.039.
Endoventricular patch plasty (the Dor procedure) has gained favor as a surgical treatment for heart failure associated with large anteroapical myocardial infarction. We tested the hypothesis that the Dor procedure reduces left ventricular volume, increases end-systolic elastance, decreases diastolic compliance, and maintains left ventricular function.
In 6 male Dorsett sheep, the left anterior descending coronary artery and its second diagonal branch were ligated 40% of the distance from apex to base. Sixteen weeks after myocardial infarction, a Dor procedure was performed with a Dacron patch that was 50% of the infarct neck dimension. Absolute left ventricular volume was measured with magnetic resonance imaging, and left ventricular pressure and relative left ventricular volume changes during pharmacologic preload reduction were measured with a volume conductance catheter 2 weeks before and 2 and 6 weeks after the Dor procedure. End-systolic elastance, diastolic compliance, and Starling relationships were calculated from the resultant left ventricular pressure/volume loops.
Two weeks after the Dor procedure, the left ventricular volume at end systole and end diastole was significantly reduced, and there was no redilation at 6 weeks. Six weeks after the Dor procedure, the ejection fraction was significantly increased. Although stroke volume increased slightly at 6 weeks, the change was not significant. The slopes of end-systolic elastance, diastolic compliance, and Starling relationships were unchanged at 2 and 6 weeks.
The Dor procedure significantly reduces left ventricular volume. Unlike linear repair, left ventricular volume changes seem stable. The ejection fraction is improved, and left ventricular function (stroke volume and the Starling relationship) is maintained.
心室内补片成形术（Dor手术）已成为治疗与大面积前壁心肌梗死相关的心力衰竭的一种外科治疗方法并受到青睐。我们检验了以下假设：Dor手术可减少左心室容积，增加收缩末期弹性，降低舒张期顺应性，并维持左心室功能。
对6只雄性多塞特羊，在距心尖至心底距离的40%处结扎左前降支冠状动脉及其第二对角支。心肌梗死后16周，采用一块尺寸为梗死灶颈部尺寸50%的涤纶补片进行Dor手术。在Dor手术前2周以及手术后2周和6周，使用容积传导导管通过磁共振成像测量左心室绝对容积，并测量药理学上降低前负荷期间的左心室压力和左心室容积相对变化。根据所得的左心室压力/容积环计算收缩末期弹性、舒张期顺应性和斯塔林关系。
Dor手术后2周，收缩末期和舒张末期的左心室容积显著减小，6周时无再扩张。Dor手术后6周，射血分数显著增加。尽管6周时每搏输出量略有增加，但变化不显著。收缩末期弹性、舒张期顺应性和斯塔林关系的斜率在2周和6周时未改变。
Dor手术显著减少左心室容积。与线性修复不同，左心室容积变化似乎稳定。射血分数得到改善，左心室功能（每搏输出量和斯塔林关系）得以维持。
