Kao R L, Christlieb I Y, Magovern G J, Park S B, Magovern G J
Surgical Research, Allegheny-Singer Research Institute, Pittsburgh, PA 15212.
J Thorac Cardiovasc Surg. 1990 Jan;99(1):134-9; discussion 139-40.
Dynamic cardiomyoplasty has been performed clinically to provide a substitute for myocardium, to assist dyskinetic ventricles, and to benefit patients with Chagas disease or dilated cardiomyopathy. Encouraging results have been observed for the patients; however, a conclusive experimental study is not available. How to use conditioned skeletal muscle for maximal augmentation of cardiac function in an appropriate animal model is the goal of this study. Dogs were used for heart failure induction, for single versus burst muscle stimulation, and for cardiac function augmentation. Muscle transformation was documented by histochemical evaluations. Propranolol infusion (3 mg/kg) induced temporary heart failure for 4 to 6 hours with significantly decreased cardiac output and blood pressure. Dynamic cardiomyoplasty significantly improved hemodynamic function during induced heart failure with better improvement by multiple (burst) stimulation as compared with single stimulation. Skeletal muscle fiber orientation is a critical factor for the success of this procedure. Our results indicated that skeletal muscle fiber oriented circumferential to the heart and perpendicular to the ventricular septum is the preferred procedure for dynamic cardiomyoplasty.
动态心肌成形术已在临床上用于替代心肌、辅助运动障碍的心室，并使恰加斯病或扩张型心肌病患者受益。已观察到患者有令人鼓舞的结果；然而，尚无确凿的实验研究。如何在合适的动物模型中使用经预处理的骨骼肌以最大程度增强心脏功能是本研究的目标。使用狗进行心力衰竭诱导、单次与爆发式肌肉刺激以及心脏功能增强实验。通过组织化学评估记录肌肉转化情况。静脉注射普萘洛尔（3毫克/千克）可诱导4至6小时的暂时性心力衰竭，心输出量和血压显著降低。动态心肌成形术在诱导心力衰竭期间显著改善了血流动力学功能，与单次刺激相比，多次（爆发式）刺激的改善效果更好。骨骼肌纤维方向是该手术成功的关键因素。我们的结果表明，骨骼肌纤维沿心脏圆周方向且垂直于心室间隔排列是动态心肌成形术的首选方法。
