Dynamic Ventriculoplasty with Electrically Stimulated Sleletal Muscle Graft For Complex Cardiac Anomaly.

目的：本实验研究的目的是建立电刺激骨骼肌移植物动态心室成形术治疗复杂心脏异常的新手术方法。方法：在12只杂种犬中，用延长的心包补片重建切除的右心室游离壁，模拟右心室发育不全（RV）的补片扩大。将长期预处理背阔肌移植物置于贴片上，并用训练脉冲（20 Hz）电驱动。另外16只狗在体外循环（CPB）模拟单室心脏时，RV腔完全消失。改良的fontan循环建立在RA和PA之间吻合的主动脉同种移植物，合并心包袋作为压缩室。CPB终止后，应用背阔肌移植物包裹心包袋，并以训练脉冲（20 Hz）刺激。结果：移植物起搏可显著提高右心室血流和肺压力（分别为158*21%、156*14%），有助于右心室发育不全模型恢复正常功能。在单室心脏改良Fontan程序的设置中证实了类似的右心功能增强。在一些动物中，连续起搏7小时无肌肉疲劳、血栓栓塞和肌肉变性的迹象。结论：电刺激骨骼肌肌室成形术可以在生理预负荷下恢复正常的心室功能，并可能为某些类型的心脏异常提供手术选择。

PURPOSE : The purpose of this experimental study is to establish new surgical procedures of dynamic ventriculoplasty with an electrically stimulated skeletal muscle graft for complex cardiac anomaly.METHODS : In 12 mongrel dogs, a resected RV free wall was reconstructed with a extended pericardial patch, simulating patch enlargement of the hypoplastic right ventricle (RV). A chronically preconditioned latissimus dorsi graft was placed onto the patch, and was electrically driven with a trained-pulse (20 Hz) . In the other 16 dogs, RV cavity was completely obliterated during a cardiopulmonary bypass (CPB) to simulate univentricular hearts. A modified-Fontan circulation was established with the aortic homograft anastomosed between RA and PA, incorporated with a pericardial pouch as a compression chamber. After a termination of CPB, A latissimus dorsi graft was applied to wrap the pericardial pouch and was stimulated with a trained-pulse (20 Hz).Results : Graft pacing showed significant augmentation of pulmonary flow and pressure (158*21%, 156*14%, respectively), contributing to restoring normal RV function in the hypoplastic RV model. Similar augmentation of the right heart performance was confirmed in a setting of the modified Fontan procedure for univentricular heart.Continuous pacing was performed in some animals for 7 hours without evidence of muscle fatigue, thromboembolism and muscle degenaration..Conclusions : Myo-Ventriculoplasty with electrically stimulated skeletal muscle can restore normal RV performance at a physiological preload, and may provide a surgical option for some types of cardiac anomaly.