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The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 124-131, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
KF Lee, RJ Dignan, JM Parmar, CM Dyke, G Benton, T Yeh Jr, AS Abd-Elfattah and AS Wechsler
We tested the hypothesis that dynamic cardiomyoplasty produces beneficial
changes in the functional mechanics of the dilated, failing left ventricle.
Chronic dilated cardiomyopathy was induced in seven mongrel dogs by rapid
ventricular pacing (260 beats/min) for 3 to 4 weeks. After completion of
the induction period, dynamic cardiomyoplasty was performed with the left
latissimus dorsi muscle, paced synchronously with the R waves of the
electrocardiogram (Medtronic SP1005). Instruments included an aortic flow
probe, a left ventricular Millar pressure catheter, and piezoelectric
sonomicrometric crystals on the left ventricle for measurements of wall
thickness and minor and major axis dimensions. Data were obtained with the
stimulator off and on. Statistical comparisons were made with Student's t
test for paired data. Dynamic cardiomyoplasty increased the cardiac output
of the failing heart (966 +/- 124 versus 1166 +/- 112 ml/min; p less than
0.01). Systolic shortening of both minor and major axis dimensions
increased (3.1 +/- 0.3 versus 4.7 +/- 0.3 mm, p less than 0.01, and 4.6 +/-
0.3 versus 7.3 +/- 0.9 mm, p less than 0.05, respectively). Left
ventricular end-diastolic pressure decreased by 16% (18 +/- 1 versus 15 +/-
1 mm Hg, p less than 0.01). Although skeletal muscle contraction increased
the pressure development in the left ventricular chamber, mean systolic
wall stress was diminished by concomitant changes in left ventricular
dimensions (116,144 +/- 11,530 versus 101,268 +/- 7464 dynes/cm2, p less
than 0.05). At end-systole, wall thickness increased (11.8 +/- 1.1 versus
12.7 +/- 1.1 mm, p less than 0.01), minor axis dimension decreased (51.3
+/- 1.4 versus 49.2 +/- 1.8 mm, p less than 0.01), and major axis dimension
also decreased (85.6 +/- 3.3 versus 79.0 +/- 2.3 mm, p less than 0.05). Our
detailed evaluation of left ventricular chamber mechanics suggests that
dynamic cardiomyoplasty may have a role in ameliorating the functional and
mechanical derangements associated with progression of dilated
cardiomyopathy both by augmenting cardiac performance and by diminishing
determinants of myocardial oxygen consumption. (All values are expressed as
mean +/- standard error of the mean.)
ARTICLES
Effects of dynamic cardiomyoplasty on left ventricular performance and myocardial mechanics in dilated cardiomyopathy
Division of Cardiothoracic Surgery, Medical College of Virginia, Richmond 23298.
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V. F. Blood, M. G. Magno, W. F. Bailey, Y. Shi, L. Yurgenev, F. DiMeo, R. N. Edie, and J. D. Mannion Basic fibroblast growth factor identified in chronically stimulated cardiomyoplasties Ann. Thorac. Surg., November 1, 1994; 58(5): 1320 - 1326. [Abstract] [PDF]
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P. W. Cho, H. R. Levin, C. C. Moore, J. E. Tsitlik, E. R. McVeigh, T. J. Gardner, and M. A. Acker New method for mechanistic studies of cardiomyoplasty: Three-dimensional MRI reconstructions Ann. Thorac. Surg., June 1, 1994; 57(6): 1605 - 1611. [Abstract] [PDF]
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O. Jegaden, F. Delahaye, G. Finet, F. Van Der Veen, P. Montagna, A. Eker, J. Ossete, R. Rossi, A. S. Pierre, and P. H. Mikaeloff Late hemodynamic results after cardiomyoplasty in congestive heart failure Ann. Thorac. Surg., May 1, 1994; 57(5): 1151 - 1157. [Abstract] [PDF]
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O. Kawaguchi, Y. Goto, S. Futaki, Y. Ohgoshi, H. Yaku, and H. Suga The effects of dynamic cardiac compression on ventricular mechanics and energetics: Role of ventricular size and contractility J. Thorac. Cardiovasc. Surg., March 1, 1994; 107(3): 850 - 859. [Abstract] [Full Text]
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H. Nakajima, H. Niinami, T. L. Hooper, R. L. Hammond, H. O. Nakajima, H. Lu, R. Ruggiero, G. A. Thomas, F. W. Mocek, R. Fietsam Jr, et al. Cardiomyoplasty: Probable mechanism of effectiveness using the pressure-volume relationship Ann. Thorac. Surg., February 1, 1994; 57(2): 407 - 415. [Abstract] [PDF]
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S. E. Park, B. L. Cmolik, R. R. Lazzara, D. R. Trumble, and J. A. Magovern Right latissimus dorsi cardiomyoplasty augments left ventricular systolic performance Ann. Thorac. Surg., December 1, 1993; 56(6): 0003497593906688 - 3497593906688. [Abstract] [PDF]
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J. A. Magovern, G. J. Magovern, T. D. Maher, D. H. Benckart, S. B. Park, I. Y. Christlieb, and G. J. Magovern Operation for congestive heart failure: Transplantation, coronary artery bypass, and cardiomyoplasty Ann. Thorac. Surg., September 1, 1993; 56(3): 418 - 425. [Abstract] [PDF]
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R. Ruggiero, G. A. Thomas, H. Niinami, H. Lu, T. L. Hooper, R. L. Hammond, R. Fietsam Jr, F. W. Mocek, H. Nakajima, H. O. Nakajima, et al. Double cardiomyoplasty: Acute versus chronic results Ann. Thorac. Surg., July 1, 1993; 56(1): 31 - 37. [Abstract] [PDF]
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P. W. Cho, H. R. Levin, W. E. Curtis, J. E. Tsitlik, J. M. DiNatale, D. A. Kass, T. J. Gardner, R. W. Kunel, and M. A. Acker Pressure-volume analysis of changes in cardiac function in chronic cardiomyoplasty Ann. Thorac. Surg., July 1, 1993; 56(1): 38 - 45. [Abstract] [PDF]
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W. Cheng, J. J. Michele, F. G. Spinale, J. D. Sink, and W. P. Santamore Effects of cardiomyoplasty on biventricular function in canine chronic heart failure Ann. Thorac. Surg., April 1, 1993; 55(4): 893 - 901. [Abstract] [PDF]
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R. W. J. Millner, M. Burrows, I. Pearson, and J. R. Pepper Dynamic cardiomyoplasty in chronic left ventricular failure: An experimental model Ann. Thorac. Surg., February 1, 1993; 55(2): 493 - 501. [Abstract] [PDF]
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L. F. P. Moreira, E. A. Bocchi, N. A. G. Stolf, F. Pileggi, and A. D. Jatene Current expectations in dynamic cardiomyoplasty Ann. Thorac. Surg., January 1, 1993; 55(1): 299 - 303. [Abstract] [PDF]
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