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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 1207-1213, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
W Cheng, AG Justicz, MS Soberman, NP Alazraki, WP Santamore and JD Sink
The effects of cardiomyoplasty were evaluated with multiple-gated
equilibrium radionuclide angiocardiography and catheterization in a canine
model of chronic heart failure. Doxorubicin was administered to 12 dogs at
a dose of 1 mg/kg/wk intravenously for 10 weeks. Left ventricular ejection
fraction was reduced from a mean of 53.6% +/- 3.4% to 33.5% +/- 2.3%
preoperatively. Two dogs died of presumed arrhythmia during this period.
Cardiomyoplasty with the left latissimus dorsi muscle was performed on 10
dogs. The muscle was wrapped around both the left and right ventricles.
Five dogs died of infection or arrhythmia after the operation.
Postoperatively the muscle remained unstimulated for 2 weeks to allow
adhesion to the heart. After this period, the latissimus dorsi muscle was
conditioned by a progressive stimulation protocol. After the muscle was
conditioned, multiple-gated equilibrium radionuclide angiocardiography
studies showed that left ventricular global ejection fraction was 18.4% +/-
7.2% at 0 volts (nonstimulation), 26.2% +/- 3.7% at 5-volt stimulation (p
less than 0.05), and 31.0% +/- 5.4% at 10-volt stimulation (p less than
0.05). Regional ejection fractions in low lateral, apical, and low septal
regions at 5 volts and 10 volts were higher than those at 0 volts (p less
than 0.05). Regional wall motion (percent radial shortening) of the low
lateral region was higher than that during nonstimulation (p less than
0.05). Peak emptying rate was 2.07 +/- 0.95 end-diastolic counts per second
at 0-volt, 3.10 +/- 0.67 at 5-volt, and 3.34 +/- 0.89 at 10-volt
stimulation (p less than 0.05). Peak filling rate was 1.81 +/- 0.52
end-diastolic counts per second at 0-volt, 2.67 +/- 1.18 at 5- volt, and
3.11 +/- 0.65 at 10-volt stimulation (p less than 0.05). Cardiac
catheterization data showed a nonsignificant increase in left ventricular
rate of pressure rise with increasing voltage (1302 +/- 355 mm Hg/sec at 0
volts, 1450 +/- 413 mm Hg/sec at 5 volts, and 1568 +/- 455 mm Hg/sec at 10
volts). Left ventricular systolic pressures were unchanged. End-diastolic
pressures decreased (11.2 +/- 1.48 mm Hg at 0 volts, 10.4 +/- 2.30 mm Hg at
5 volts, and 9.6 +/- 1.52 at 10 volts; p less than 0.05). These data show
that cardiomyoplasty can improve indices of systolic and diastolic function
in a canine model of chronic heart failure.
ARTICLES
Effects of dynamic cardiomyoplasty on indices of left ventricular systolic and diastolic function in a canine model of chronic heart failure
Department of Cardiothoracic Surgery, Philadelphia Heart Institute, Presbyterian Medical Center, PA 19104.
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