Klima U, Guerrero J L, Levine R A, Vlahakes G J
Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston 02114-2696, USA.
Transplantation. 1997 Jul 27;64(2):215-22. doi: 10.1097/00007890-199707270-00006.
Current heterotopic heart transplant models have nonworking left ventricles that atrophy and are not suitable for some studies. We developed and characterized a new heterotopic model with working left and right ventricles.
Hemodynamics were compared in the working and nonworking models. The influence of the length of the donor's aorta on coronary arterial oxygenation was tested. The influence of the recipient's arterial pressure on developed left ventricular systolic pressure and the effects of alpha- and beta-adrenergic stimulation were examined in both models. The nonworking and working models were compared in chronic transplant preparations to investigate possible ventricular atrophy.
In this model, coronary arterial oxygen tension was influenced by the length of the donor's aorta. With a short donor aorta (0.5 cm in the porcine model), normal coronary arterial oxygenation is maintained. Left ventricular systolic pressure was greater in the working compared with the nonworking models. Left ventricular systolic pressure did not respond to alpha-adrenergic stimulation but did respond to beta-adrenergic and combined stimulation, which indicates its relationship to donor heart output. Left ventricular systolic pressure correlated with and was determined by recipient arterial pressure. Ventricular atrophy occurred in the nonworking model, but ventricular weight was maintained at sham control levels in this new working model.
These results demonstrate the surgical anatomic considerations of a new heterotopic heart transplant model in which the left and right ventricles work. Its hemodynamic performance is related to recipient hemodynamics, and the model responds to adrenergic stimulation. In chronic studies, ventricular mass is maintained, thus allowing this model to overcome a significant shortcoming of existing heterotopic heart transplant models.
目前的异位心脏移植模型中，左心室不工作且萎缩，不适用于某些研究。我们开发并描述了一种新的具有工作状态的左、右心室的异位模型。
比较工作模型和非工作模型的血流动力学。测试供体主动脉长度对冠状动脉氧合的影响。在两种模型中研究受体动脉压对左心室舒张末期压力的影响以及α和β肾上腺素能刺激的作用。在慢性移植制剂中比较非工作模型和工作模型，以研究可能的心室萎缩。
在该模型中，冠状动脉氧张力受供体主动脉长度的影响。供体主动脉较短（猪模型中为0.5厘米）时，可维持正常的冠状动脉氧合。与非工作模型相比，工作模型中的左心室收缩压更高。左心室收缩压对α肾上腺素能刺激无反应，但对β肾上腺素能刺激和联合刺激有反应，这表明其与供体心脏输出的关系。左心室收缩压与受体动脉压相关并由其决定。非工作模型中出现心室萎缩，但在这种新的工作模型中，心室重量维持在假手术对照组水平。
这些结果证明了一种新的左、右心室工作的异位心脏移植模型的手术解剖学考虑因素。其血流动力学性能与受体血流动力学相关，且该模型对肾上腺素能刺激有反应。在慢性研究中，心室质量得以维持，从而使该模型克服了现有异位心脏移植模型的一个重大缺点。
