Chachques J C, Grandjean P A, Pfeffer T A, Perier P, Dreyfus G, Jebara V, Acar C, Levy M, Bourgeois I, Fabiani J N
Department of Cardiovascular Surgery, Hospital Broussais, Paris, France.
J Heart Transplant. 1990 May-Jun;9(3 Pt 1):239-51.
Dynamic cardiomyoplasty was conceived to enhance cardiac performance by assisting myocardial contraction. Technically, this procedure consists of placing a pedicled latissimus dorsi muscle flap around the heart and subsequent muscle electrostimulation in synchrony with ventricular systole. Three types of dynamic cardiomyoplasty can be considered. (1) Atrial or ventricular reinforcement is accomplished by wrapping the latissimus dorsi muscle flap around the heart to support hypokinetic or akinetic areas secondary to congenital or acquired diseases. The atrial reinforcement may be performed to improve atrial output after Fontan-type procedures. (2) Ventricular substitution is performed to replace a portion of the ventricular wall. Autologous pericardium is used to create a neoendocardium and facilitate hemostatic closure of the ventricle. The pedicled latissimus dorsi is then secured to replace the resected myocardium. (3) The two previous techniques of ventricular substitution and reinforcement are combined. This reconstructive procedure, which normalizes the ventricular geometrical shape, is particularly useful after extended cardiac resections, such as is done in treatment of large ventricular aneurysms, cardiac tumors, or echinococcal cyst formations. At present, improvement in ventricular function has been obtained in 12 patients at our institution. Preoperative severe cardiac dysfunction was present in all of these patients (New York Heart Association functional class III or IV). Postoperative echocardiography, multigated acquisition scan, and hemodynamic studies demonstrate an improvement in ventricular function and no impairment of ventricular compliance by the muscle flap. After a mean follow-up period of 18 months, all patients are in functional class I or II. We believe that dynamic cardiomyoplasty prolongs and improves the quality of life of patients suffering from severe chronic and irreversible myocardial dysfunction by improving ventricular contraction and limiting cardiac dilatation.
动力性心肌成形术旨在通过辅助心肌收缩来增强心脏功能。从技术上讲，该手术包括将带蒂的背阔肌肌瓣环绕心脏放置，并随后与心室收缩同步进行肌肉电刺激。动力性心肌成形术可分为三种类型。（1）心房或心室增强是通过将背阔肌肌瓣环绕心脏包裹，以支持先天性或后天性疾病继发的运动减弱或运动不能区域。在Fontan类手术后，可进行心房增强以改善心房输出。（2）心室替代是用于替换部分心室壁。使用自体心包创建新内膜并促进心室的止血闭合。然后固定带蒂背阔肌以替代切除的心肌。（3）将先前的心室替代和增强这两种技术结合起来。这种使心室几何形状正常化的重建手术，在进行广泛的心脏切除术后特别有用，例如在治疗大型心室瘤、心脏肿瘤或棘球蚴囊肿形成时。目前，我们机构的12例患者心室功能得到改善。所有这些患者术前均存在严重心脏功能障碍（纽约心脏协会心功能分级为III级或IV级）。术后超声心动图、多门控心血池扫描和血流动力学研究表明心室功能有所改善，且肌瓣未损害心室顺应性。平均随访18个月后，所有患者的心功能分级为I级或II级。我们认为，动力性心肌成形术通过改善心室收缩和限制心脏扩张，延长并改善了患有严重慢性和不可逆心肌功能障碍患者的生活质量。
