Moreira L F, Stolf N A, Bocchi E A, Pereira-Barretto A C, Meneghetti J C, Giorgi M C, Moraes A V, Leite J J, da Luz P L, Jatene A D
Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Brazil.
Circulation. 1990 Nov;82(5 Suppl):IV257-63.
Stimulated skeletal muscle grafts have been proposed as a means to reinforce ventricular wall in the treatment of severe myocardial failure. Latissimus dorsi cardiomyoplasty was performed in 11 patients with advanced heart failure due to cardiomyopathy who were in New York Heart Association (NYHA) class III or IV despite maximal medical therapy. There were no operative deaths. Eight patients were followed for a mean of 10.8 months. Two patients remain in muscle conditioning protocol. One patient died with latissimus dorsi ischemia and congestive heart failure. Four of the eight patients in long-term follow-up are in NYHA class I, three in class II, and one in class III. At 3 months of follow-up, rest radioisotopic left ventricular ejection fraction increased from 20.5 +/- 3.6% to 26.8 +/- 8.1% (p less than 0.01). Doppler-echocardiography demonstrated that left ventricular segmental wall shortening improved from 11.3 +/- 2.5% to 16.5 +/- 3.9% (p less than 0.01) and left ventricular stroke volume from 22.9 +/- 4.6 to 33.1 +/- 10 ml (p less than 0.01). Cardiopulmonary exercise test showed that maximal oxygen consumption during treadmill test increased from 14.8 +/- 3.7 to 18.2 +/- 3.3 ml/kg.min (p less than 0.05). At 6 months of follow-up, all the above values remained essentially unchanged. Furthermore, nonsustained ventricular tachycardia was abolished without specific medical therapy in four patients. Thus, cardiomyoplasty improves left ventricular function, reverses congestive heart failure, and may improve long-term survival in severe cardiomyopathies.
有人提出将受刺激的骨骼肌移植作为治疗严重心肌衰竭时强化心室壁的一种方法。对11例因心肌病导致晚期心力衰竭且尽管接受了最大程度药物治疗但仍处于纽约心脏协会（NYHA）Ⅲ或Ⅳ级的患者进行了背阔肌心肌成形术。无手术死亡病例。8例患者平均随访10.8个月。2例患者仍在进行肌肉训练方案。1例患者因背阔肌缺血和充血性心力衰竭死亡。长期随访的8例患者中，4例处于NYHAⅠ级，3例处于Ⅱ级，1例处于Ⅲ级。随访3个月时，静息放射性核素左心室射血分数从20.5±3.6%增至26.8±8.1%（p<0.01）。多普勒超声心动图显示左心室节段性室壁缩短从11.3±2.5%改善至16.5±3.9%（p<0.01），左心室每搏输出量从22.9±4.6增至33.1±10 ml（p<0.01）。心肺运动试验表明，跑步机试验期间最大耗氧量从14.8±3.7增至18.2±3.3 ml/kg·min（p<0.05）。随访6个月时，上述所有值基本保持不变。此外，4例患者未经特异性药物治疗非持续性室性心动过速即消失。因此，心肌成形术可改善左心室功能，逆转充血性心力衰竭，并可能提高严重心肌病患者的长期生存率。
