Lucas C M, Van der Veen F H, Cheriex E C, Lorusso R, Havenith M, Penn O C, Wellens H J
Department of Cardiology, University of Limburg, Maastricht, The Netherlands.
J Am Coll Cardiol. 1993 Sep;22(3):758-67. doi: 10.1016/0735-1097(93)90188-7.
To obtain information on the long-term effects of dynamic cardiomyoplasty on hemodynamics and muscle histology, this surgical method was evaluated in goats.
Dynamic cardiomyoplasty has been introduced as a new method to treat patients with severe cardiac failure.
In 24 goats, the left latissimus dorsi muscle was wrapped around the heart. The muscle was then subjected to progressive electrical stimulation. In 16 goats, invasive transesophageal Doppler echocardiographic measurements and histologic evaluation of the latissimus dorsi muscle were performed at > or = 12 weeks after the wrapping.
Only two goats showed an increase in aortic and left and right ventricular pressures concomitant with increased aortic flow during latissimus dorsi muscle stimulation both before and after induction of cardiac failure using imipramine. This was accompanied by a preserved latissimus dorsi muscle structure and nearly complete transformation to type I muscle fibers. The remaining 14 goats showed extensive lipomatosis in the latissimus dorsi muscle, with severe intimal hyperplasia and proliferation of smooth muscle cells in the walls of the thoracodorsal artery and its branches. An increase in endoneural and endomysial connective tissue was observed, with some goats showing destroyed nerve branches near the electrodes. These findings differed from those observed after long-term electrical stimulation of goat latissimus dorsi muscle in situ.
Dynamic cardiomyoplasty is of use in the treatment of severe heart failure if the histologic structure of the wrapped latissimus dorsi muscle remains intact. Long-term results in goats suggest that the current approach used in dynamic cardiomyoplasty may lead to deterioration of the wrapped muscle.
为获取动态心肌成形术对血流动力学和肌肉组织学长期影响的信息，在山羊身上对该手术方法进行了评估。
动态心肌成形术已作为治疗严重心力衰竭患者的一种新方法被引入。
在24只山羊身上，将背阔肌包裹在心脏周围。然后对该肌肉进行逐步电刺激。在16只山羊中，在包裹术后≥12周时进行有创经食管多普勒超声心动图测量以及背阔肌的组织学评估。
仅两只山羊在使用丙咪嗪诱发心力衰竭前后，背阔肌刺激期间主动脉及左、右心室压力升高，同时主动脉血流增加。这伴随着背阔肌结构的保留以及几乎完全转变为I型肌纤维。其余14只山羊的背阔肌出现广泛的脂肪变性，胸背动脉及其分支管壁出现严重的内膜增生和平滑肌细胞增殖。观察到神经内膜和肌内膜结缔组织增加，一些山羊在电极附近的神经分支遭到破坏。这些发现与原位长期电刺激山羊背阔肌后观察到的结果不同。
如果包裹的背阔肌组织结构保持完整，动态心肌成形术可用于治疗严重心力衰竭。山羊的长期结果表明，目前动态心肌成形术中使用的方法可能导致包裹肌肉的恶化。
