Paced skeletal muscle for dynamic cardiomyoplasty.
Paced skeletal muscle for dynamic cardiomyoplasty.
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用于动态心肌成形术的起搏骨骼肌。
DOI：
10.1016/s0003-4975(10)64761-3
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发表时间：
1988
期刊：
影响因子：
--
通讯作者：
R. Kao
中科院分区：
文献类型：
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作者：
G. Magovern;F. Heckler;S. B. Park;I. Christlieb;G. Liebler;J. Burkholder;T. Maher;D. Benckart;G. Magovern;R. Kao
4 名患者均具有心肌梗死和弥漫性冠状动脉疾病病史，接受了将具有完整神经血管束的左背阔肌 (LD) 应用于左心室前侧壁的治疗。 3 名患者在手术后的六周内对肌肉进行了调节，而第四名患者则在术前进行了突发刺激的调节。活检标本证实了实验数据，即人类骨骼肌可以在六到十周的时间内进行电调节，以主要含有抗疲劳的 I 型纤维。所有患者均在手术中存活下来，其中 3 名患者因动脉瘤切除术而出现改善。 1 号患者接受了改良切除术，术后 28 个月，在 75 瓦的运动水平下，射血分数为 54% 起搏，而 45% 为非起搏。 2 号患者在 12 个月时，静息射血分数为 44% 起搏，而非 30%。多普勒回波研究证实了皮瓣的存在及其在起搏和非起搏模式下的功能。第三例患者术后2个月因突发室性心律失常死亡。尸检时发现皮瓣受感染、无功能、退化。 4号患者没有动脉瘤。她接受了右冠状动脉旁路移植术，并接受了心肌固定术，试图缓解医学上难以治愈的慢性充血性心力衰竭。术后 10 个月，静息时射血分数为 33%，起搏 vs 25%。这些患者中没有出现缩窄性肌病。
Four patients, each with a history of myocardial infarction and diffuse coronary artery disease, underwent application of left latissimus dorsi (LD) muscle with intact neurovascular bundle to the anterolateral wall of the left ventricle. The muscle was conditioned over a six-week period subsequent to operation in 3 patients and was conditioned preoperatively with a burst stimulus in the fourth. Biopsy specimens confirm the experimental data that human skeletal muscle can be electrically conditioned over a six- to ten-week period to contain mainly fatigue-resistant type I fibers. All patients survived the procedure, and 3 showed improvement secondary to aneurysmectomy. In Patient 1, a modified resection was performed, and at 28 months after operation, at the 75-W level of exercise, the ejection fraction was 54% paced versus 45% nonpaced. In Patient 2, at 12 months, the ejection fraction at rest was 44% paced versus 30% nonpaced. Doppler echo studies confirmed the presence of the flap and its function in the paced and nonpaced mode. The third patient died of a sudden ventricular arrhythmia 2 months following operation. An infected, nonfunctioning, degenerated flap was found at autopsy. Patient 4 did not have an aneurysm. She received a bypass graft to the right coronary artery and underwent cardiomyopexy in an attempt to relieve medically refractory incapacitating chronic congestive heart failure. Ten months postoperatively, ejection fraction at rest was 33% paced versus 25% nonpaced. Constrictive myopathy has not been encountered in any of these patients.