Mukai T, Tsukube T, Okada M
Department of Surgery, Kobe University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Dec;41(12):2301-10.
This study was undertaken to examine the effect of cardiac assist and left ventricular function after dynamic cardiomyoplasty (DCMP). In the first group (GI) of 10 mongrel dogs DCMP was drived immediately after wrapping both ventricles by latissmus dorsi muscle flap (LDMF). In the second group (GII) of 10 mongrel dogs DCMP was derived over 6 weeks after production of DCMP for achievement of complete adhesion between LDMF and myocardium. In the both groups, aortic pressure, cardiac output, left ventricular systolic pressure, and ejection fraction of the left ventricle were significantly increased by DCMP driving (p < 0.001). But left ventricular systolic pressure was remarkably increased in GII compared with that of GI (21.2 +/- 10.2% versus 14.0 +/- 9.6%, p < 0.001), and end diastolic pressure of the left ventricle was apparently decreased in GII (61.6 +/- 42.3% p < 0.05). Thus, satisfactory results were recognized that cardiac assist for left ventricular function was enhanced after completion of adhesion between myocardium and LDMF. Echocardiography in GII demonstrated that left ventricular systolic dimention was significantly decreased from 33.8 +/- 1.0 mm to 27.6 +/- 1.2 mm (p < 0.001). Thus, left ventricular fractional shortening was significantly increased from 24.0 +/- 2.4% to 38.0 +/- 2.6% (p < 0.001). However, left ventricle end-diastolic dimention was not changed even during DCMP driving. So disturbance in left ventricular function during diastole could not be recognized. In conclusion, especially after adhesion of both muscles of LDMF and myocardium, effect of cardiac assist was remarkably enhanced, and disturbance of diastolic function of the left ventricle could not be observed.
本研究旨在探讨动态心肌成形术（DCMP）后心脏辅助及左心室功能的影响。在第一组（GI）的10只杂种犬中，在背阔肌肌瓣（LDMF）包裹双侧心室后立即进行DCMP。在第二组（GII）的10只杂种犬中，在DCMP制作6周后进行，以实现LDMF与心肌之间的完全粘连。在两组中，DCMP驱动后主动脉压、心输出量、左心室收缩压和左心室射血分数均显著增加（p < 0.001）。但与GI组相比，GII组的左心室收缩压显著升高（21.2 +/- 10.2%对14.0 +/- 9.6%，p < 0.001），且GII组的左心室舒张末期压力明显降低（61.6 +/- 42.3%，p < 0.05）。因此，在心肌与LDMF之间完成粘连后，左心室功能的心脏辅助得到增强，取得了满意的结果。GII组的超声心动图显示，左心室收缩内径从33.8 +/- 1.0 mm显著减小至27.6 +/- 1.2 mm（p < 0.001）。因此，左心室缩短分数从24.0 +/- 2.4%显著增加至38.0 +/- 2.6%（p < 0.001）。然而，即使在DCMP驱动期间，左心室舒张末期内径也没有变化。因此，未发现舒张期左心室功能障碍。总之，特别是在LDMF和心肌两者粘连后，心脏辅助效果显著增强，且未观察到左心室舒张功能障碍。
