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J Thorac Cardiovasc Surg 1999;117:198-199
© 1999 Mosby, Inc.

LETTERS TO THE EDITOR

A stable model of chronic bilateral ventricular insufficiency (dilated cardiomyopathy) induced by arteriovenous anastomosis and doxorubicin administration in sheep

To the Editor

Congratulations to Toyoda, Okada, and KashemGo 1 on their recent article, "A Canine Model of Dilated Cardiomyopathy Induced by Repetitive Intracoronary Doxorubicin Administration." We need such a simple and reproducible animal model of stable, nonreversible chronic heart failure if we are to evaluate new surgical treatments for pre–end-stage congestive heart failure. The authors described cannulation of the coronary artery via the femoral artery and transcatheter infusion of doxorubicin, which resulted in visible signs of left ventricular insufficiency after 5 weekly doses of intracoronary doxorubicin; however, they reported that "the right ventricle seemed to be affected only slightly by doxorubicin." Especially for cardiomyopathy research, one needs to create a model of bilateral heart failure.

In a recently completed (unpublished) investigation involving adult sheep, we created a bilateral model through first inducing right ventricular insufficiency by a surgical anastomosis between the right jugular vein and right external cardiac artery. After 1 month, we observed initial signs of insufficiency in the right ventricle (Table I) but not in the left. At this point, we began daily administration of (intravenous, not intracoronary) doxorubicin, which continued for the next 4 weeks and resulted in left ventricular insufficiency (Table II).


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  		Table I. Right ventricular hemodynamic results after creation of an arteriovenous anastomosis and administration of intravenous doxorubicin
 

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  		Table II. Left ventricular hemodynamic results after creation of an arteriovenous anastomosis and administration of intravenous doxorubicin
 
Please note that we made no attempt to determine whether the anastomosis or doxorubicin had the greater effect in inducing right ventricular insufficiency, although Toyoda, Okada, and Kashem observed that 5 weekly doses of the drug were insufficient for the purpose. On the other hand, Smink and colleaguesGo 2 induced quite stable bilateral ventricular insufficiency after an anastomosis was in place for only 3 months.

The combined evidence of these investigations points toward the necessity of using both an arteriovenous anastomosis and doxorubicin for a stable model of bilateral chronic heart failure. A model of bilateral heart failure can be especially useful for comparing surgical methods of treating pre–end-stage congestive heart failure, that is, cardiomyoplasty, partial ventriculectomy, or implantation of artificial ventricular assist devices.

Valeri S. Chekanov MD, PhD
Milwaukee Heart Institute
Sinai Samaritan Medical Center
PO Box 342
960 North Twelfth St
Milwaukee, WI 53201-0342

12/8/94496

References

  1. Toyoda Y, Okada M, Kashem MA. A canine model of dilated cardiomyopathy induced by repetitive intracoronary doxorubicin administration. J Thorac Cardiovasc Surg 1998;115:1367-73. [Abstract/Free Full Text]
  2. Smink M, Van der Veen FH, Prenger K, Schrender YY, Ventricular reduction surgery in grafts with dilated hearts. Basic Appl Myology 1998;8:236.



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