新技术测量心肌成形术中跨壁心肌压力降低情况。
New technique measures decreased transmural myocardial pressure in cardiomyoplasty.
作者信息
Chen F Y, Aklog L, deGuzman B J, Laurence R G, Couper G S, Appleyard R F, Cohn L H, McMahon T A
机构信息
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
Ann Thorac Surg. 1995 Dec;60(6):1678-82. doi: 10.1016/0003-4975(95)00713-X.
BACKGROUND
We introduce the use of a fluid-filled balloon, interposed between myocardium and latissimus dorsi (LD), as a new technique to measure transmural myocardial pressure in an acute goat model of dynamic cardiomyoplasty.
METHODS
A half-ellipsoidal balloon, composed of polychloryl vinyl layers, was sutured to the atrioventricular groove in 5 goats, thereby completely enveloping both ventricles. Left LD dynamic cardiomyoplasty was then performed, anchoring the LD to the felt sewing skirt of the balloon so that the LD completely covered the balloon. Left ventricular pressure and balloon pressure were measured with the stimulator in the 1:2 mode as balloon volume was varied.
RESULTS
Average transmural myocardial pressure, defined as left ventricular pressure minus balloon pressure, decreased from 34.4 mm Hg to 15.6 mm Hg during stimulator-on beats (p < 0.05).
CONCLUSION
These results support the conclusion that dynamic cardiomyoplasty unloads the left ventricle by decreasing wall stress. Furthermore, transmural myocardial pressure decreased more when balloon volume was increased, implying that the LD sarcomere length has an effect on wall stress. A balloon may therefore allow optimization of LD sarcomere length and thus assisted cardiac performance.
背景
我们介绍一种在急性山羊动力性心肌成形术模型中，置于心肌与背阔肌（LD）之间的充液球囊，作为测量透壁心肌压力的新技术。
方法
将一个由聚氯乙烯层组成的半椭圆形球囊缝合到5只山羊的房室沟，从而完全包裹两个心室。然后进行左LD动力性心肌成形术，将LD固定到球囊的毡制缝合裙上，使LD完全覆盖球囊。随着球囊容积的变化，在刺激器处于1:2模式下测量左心室压力和球囊压力。
结果
平均透壁心肌压力定义为左心室压力减去球囊压力，在刺激器开启搏动期间从34.4毫米汞柱降至15.6毫米汞柱（p<0.05）。
结论
这些结果支持以下结论，即动力性心肌成形术通过降低壁应力减轻左心室负荷。此外，当球囊容积增加时，透壁心肌压力下降得更多，这意味着LD肌节长度对壁应力有影响。因此，球囊可能允许优化LD肌节长度，从而改善心脏功能。
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