Feindt Peter, Boeken Udo, Litmathe J, Gams Emmeran
Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Hospital Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
Interact Cardiovasc Thorac Surg. 2003 Dec;2(4):575-80. doi: 10.1016/S1569-9293(03)00172-5.
End-stage heart failure is an increasing clinical problem with only a few satisfactory therapeutic options. Dilated cardiomyopathy (DCM) is associated with a progressive decline in cardiac function. Our hypothesis was to arrest this worsening of cardiac function by mechanical containment of the dilating heart. In 16 pigs (50+/-7 kg) DCM with congestive heart failure was initiated by rapid ventricular pacing (220 beats/m) for at least 4 weeks. In group I (n=8) an elastic net was placed around both ventricles before pacing was induced, whereas in group II (n=8) only the catheters for hemodynamic measurements were implanted. Comparing hemodynamic data the decrease of cardiac output (CO) and dp/dt(max) during the period of stimulation was significantly lower in group I than in group II (CO: gr. I: -1.4 l/min; gr. 2: -4.1 l/min/dp/dt(max): gr. II: +288 mmHg/s; gr. 2: -1350 mmHg/s). This observation could also be made concerning the maximal left ventricular pressure (LVP(max): gr. I: +8.6 mmHg; gr. II: -39.4 mmHg). Ventricular containment with an elastic net seems to be a prophylactic option in cardiac insufficiency caused by ventricular dilation. This 'cardioplasty' is able to reduce the development of such a dilation with concomitant heart failure.
终末期心力衰竭是一个日益严重的临床问题，可供选择的满意治疗方案寥寥无几。扩张型心肌病（DCM）与心脏功能的逐渐衰退有关。我们的假设是通过对扩张的心脏进行机械性约束来阻止心脏功能的恶化。在16头猪（体重50±7千克）身上，通过快速心室起搏（220次/分钟）至少4周来诱发伴有充血性心力衰竭的DCM。在第一组（n = 8）中，在诱发起搏前在两个心室周围放置一个弹性网，而在第二组（n = 8）中仅植入用于血流动力学测量的导管。比较血流动力学数据，刺激期间第一组的心输出量（CO）和dp/dt（max）的下降明显低于第二组（CO：第一组：-1.4升/分钟；第二组：-4.1升/分钟/dp/dt（max）：第一组：+288毫米汞柱/秒；第二组：-1350毫米汞柱/秒）。关于最大左心室压力（LVP（max））也有类似观察结果（第一组：+8.6毫米汞柱；第二组：-39.4毫米汞柱）。用弹性网进行心室约束似乎是心室扩张所致心脏功能不全的一种预防性选择。这种“心脏成形术”能够减少这种伴有心力衰竭的扩张的发展。
