Morita K, Kurosawa H, Ishii S, Koyanagi K, Kanazawa T, Yoshitake M, Nagahori R
Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan.
Kyobu Geka. 1995 Aug;48(9):745-8.
The purpose of this experimental study is to evaluate the efficacy of linear-type right ventricular (RV) dynamic cardiomyoplasty in a setting of patch enlargement model for hypoplastic RV. In 6 puppies (6-8 kg), under a cardiopulmonary bypass (CPB), RV free wall and septal traveculation were resected and replaced with large pericardial patch, simulating RV patch enlargement of hypoplastic RV. A pedicled left LD, anchored to 3rd rib, wrapped onto the RV patch in parallel to RV long axis, while LD fixed to only RV diaphragma surface without wrapping LV surface. After the termination of CPB, LD flap was synchronously paced at 1:1 ratio with cardiac beat with a trained-pulse stimuli (10-25 Hz). RV performance was tested by RV function curve (RVSWI vs CVP) and RV pressure-volume relationship (ESPVR) assessed by conductance catheter.
LD graft stimuration showed significant augmentation of PAP (145 +/- 21%), PA flow (152 +/- 21%) and AP (128 +/- 23%) at CVP of 10 mmHg. RV function curve and ESPVR confirmed dramatical augmentation of RV performance by graft stimulation, which was identical to preoperative normal RV function even at the low CVP range.
Linear LD myoplasty after patch enlargement of RV may viable surgical option for hypoplastic RV.
本实验研究的目的是评估在右心室发育不全的补片扩大模型中线性型右心室（RV）动力性心肌成形术的疗效。在6只幼犬（6 - 8千克）中，在体外循环（CPB）下，切除右心室游离壁和间隔小梁，并用大的心包补片替代，模拟右心室发育不全的右心室补片扩大。将带蒂的左背阔肌（LD）固定于第3肋骨，沿右心室长轴平行包裹在右心室补片上，而LD仅固定于右心室膈面，不包裹左心室表面。体外循环结束后，用训练脉冲刺激（10 - 25赫兹）以1:1的比例与心跳同步起搏背阔肌皮瓣。通过右心室功能曲线（右心室每搏作功指数与中心静脉压）和用导电导管评估的右心室压力 - 容积关系（舒张末期压力 - 容积关系）来测试右心室功能。
在中心静脉压为10 mmHg时，背阔肌移植刺激显示肺动脉压（PAP）显著升高（145±21%）、肺动脉血流（PA flow）显著升高（152±21%）和主动脉压（AP）显著升高（128±23%）。右心室功能曲线和舒张末期压力 - 容积关系证实了移植刺激使右心室功能显著增强，即使在低中心静脉压范围内也与术前正常右心室功能相同。
右心室补片扩大后进行线性背阔肌肌成形术可能是右心室发育不全可行的手术选择。
