Transformation of Denervated Sleletal Muscle Graft By Chronic Electrical Stimulation and Application of Sleletal Muscle Graft for Reconstructive Cardiovascular Surgery.

慢性电刺激去神经化骨骼肌移植物的转化以及骨骼肌移植物在心血管重建手术中的应用。

• 批准号: 15591496
• 负责人: MORITA Kiyozo
• 金额: $ 2.24万
• 依托单位: Jikei University School of Medicine
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2003
• 资助国家: 日本
• 起止时间: 2003 至 2004
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-15591496/
• 关键词: univentricular heart; electrical preconditioning; skeletal muscle graft; denervation; 再生心大血管外科; 遊離グラフト; 電気刺激

PURPOSE : The purpose of this experimental study is to test the possibility of new surgical procedures of with denervated skeletal muscle graft with chronic electrical stimulation to avoid muscle atrophy, and the feasibility of dynamic Fontan procedure by paced skeletal muscle ventricle(SMV) to maintain physiological pulmonary circulation.METHODS : Preliminary experiments in 10 beagles, left lattissimus dorsi muscle grafts were electrically stimulated for 28 days after the transaction of thoracodorsal nerve to test the effects of chronic stimulation on reversal of denervation-induced atrophy. On the basis of preliminary studies, we have studied potential for pulmonary circulational assist by dynamic Fontan model with Skeletal Muscle Ventricle(SMV) construced using the latissimus dorsi muscles of 10 dogs. SMV was electrical preconditioned for 8 weeks. Under cardiopulmonary bypass(CPB), right heart(RV) bypass model was established with SMV anastomosed between the right atrium and pulmonary trunk. SMV was paced at a burst frequency of 25Hz, 60/min., an asynchronization ratio. Aortic pressure(AoP), pulmonary arterial pressure(PAP), central venous pressure(CVP), and pulmonary flow(PAF) were measured.RESULTS : Just after on-SMV, PAP and PAF were increased, CVP was decreased. CVP was decreased from 17±1.4 mmHg to 13.5±0.7 mmHg (p<0.05). PAP was increased from 20±2.8/19±1.6 mmHg (non-pulsatile flow) to 37.5±4.9/18±2.1 mmHg (pulsatile flow). Under off-SMV CVP was 18 mmHg and severe RV failure was recognized as PAF was 35% of preoperation. Under on-SMV, CVP was decreased and PAF was almost same as preoperation. On physiological CVP, RV bypass model with intrathoracic SMV keeped PAF as same as preoperation under high Rp. We conclued that this model may be aviable surgical option for univentricular heart with high Rp, which may not be a Fontan candidates.

目得：本实验研究的目的是测试采用去神经骨骼肌移植联合慢性电刺激以避免肌肉萎缩的新手术方法的可能性，以及通过起搏骨骼肌心室（SMV）进行动态Fontan手术以维持生理肺循环的可行性。方法：在10只小猎犬身上进行的初步实验，在切断胸背神经后，电刺激左侧背阔肌移植物28天，以检测慢性刺激对逆转的影响去神经引起的萎缩在此基础上，我们用10条狗的背阔肌构建了动态Fontan模型，研究了其辅助肺循环的可能性。SMV电预处理8周。在体外循环（CPB）下，将SMV置于右心房和肺动脉干之间，建立右心（RV）转流模型。SMV以25 Hz，60/min的突发频率起搏，一个分解率。结果：SMV后即刻，主动脉压（AoP）、肺动脉压（PAP）、中心静脉压（CVP）、肺动脉血流量（PAF）升高，CVP降低; CVP由17± 1.4mmHg降至13.5± 0.7mmHg（P<0.05）。PAP从20±2.8/19±1.6 mmHg（非脉动流）升高至37.5±4.9/18±2.1 mmHg（脉动流）。关闭SMV时，CVP为18 mmHg，PAF为术前的35%，被认为是严重的RV衰竭。在on-SMV下，CVP降低，PAF与术前基本相同。在生理性CVP下，胸内SMV的RV转流模型在高Rp下维持与术前相同的PAF。我们的结论是，这种模型可能是一个可行的手术选择，单心室心脏高RP，这可能不是一个Fontan候选人。