右背阔肌心肌成形术对左心室功能的早期影响。

Early effects of right latissimus dorsi cardiomyoplasty on left ventricular function.

作者信息

Magovern J A, Park S E, Cmolik B L, Trumble D R, Christlieb I Y, Magovern G J

机构信息

Cardiothoracic Surgical Research, Allegheny-Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA 15212.

出版信息

Circulation. 1993 Nov;88(5 Pt 2):II298-303.

PMID:8222169

Abstract

BACKGROUND

We hypothesized that left ventricular function could be improved with cardiomyoplasty using the right latissimus dorsi.

METHODS AND RESULTS

Five dogs underwent cardiomyoplasty using the right latissimus dorsi. Left ventricular volume and pressure were measured using sonomicrometry and a micromanometer catheter, respectively. Pressure volume loops were recorded with the muscle stimulated at 1:2 and with transient caval occlusion. During stimulated beats, there were significant increases in stroke work (13.90 +/- 4.49 vs 9.78 +/- 3.81 g/m, P < .01), preload recruitable stroke work (0.766 +/- 0.110 vs 0.594 +/- 0.207 g.m-1 x m-3, P < .05), and stroke volume (15 +/- 4 vs 10 +/- 3 mL, P < .05) when compared with unstimulated beats. There were no changes in diastolic filling. This operation was done in 11 patients, with no operative deaths. Six weeks after surgery, resting left ventricular ejection fraction (LVEF) increased from 25 +/- 1.6% to 35 +/- 3% (P < .05), and left ventricular end-diastolic volume (LVEDV) decreased from 365 +/- 18 to 307 +/- 24 mL, (P < .05). Nine patients were alive at 6 months. Preoperative and 6-month LVEF and LVEDV for those 9 patients were 26 +/- 2% and 29 +/- 2% (P = NS) and 316 +/- 23 and 261 +/- 22 mL (P < .05), respectively.

CONCLUSIONS

Long-term studies are needed to determine if these changes will improve patient survival.

摘要

背景

我们假设使用右背阔肌进行心肌成形术可改善左心室功能。

方法与结果

5只狗接受了使用右背阔肌的心肌成形术。分别使用超声心动图和微测压导管测量左心室容积和压力。在肌肉以1:2的比例刺激并短暂阻断腔静脉时记录压力容积环。与未刺激的搏动相比，在刺激搏动期间，每搏功（13.90±4.49对9.78±3.81 g/m，P<.01）、可募集前负荷每搏功（0.766±0.110对0.594±0.207 g.m-1×m-3，P<.05）和每搏输出量（15±4对10±3 mL，P<.05）均有显著增加。舒张期充盈无变化。该手术在11例患者中进行，无手术死亡。术后6周，静息左心室射血分数（LVEF）从25±1.6%增加到35±3%（P<.05），左心室舒张末期容积（LVEDV）从365±18减少到307±24 mL（P<.05）。9例患者在6个月时存活。这9例患者术前和6个月时的LVEF和LVEDV分别为26±2%和29±2%（P=无显著性差异）以及316±23和261±22 mL（P<.05）。