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Right Heart Assist by Pedicle Skeletal Muscle - An Application for Fontan's Operation

带蒂骨骼肌辅助右心——在Fontan手术中的应用

基本信息

批准号：
01570775
负责人：
HANEDA Kiyoshi
金额：
$ 1.15万
依托单位：
Tohoku University
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (C)
财政年份：
1989
资助国家：
日本
起止时间：
1989 至 1990
项目状态：
已结题

项目摘要

This study was conducted to investigate the effect of right heart assist by pedicle skeletal muscle on the hemodynamics after Fontan's operation in order to extend its operative indication. Experimental Fontan's operation model in which experimental animals could survive for long term periods was established. In comparison of the hemodynamic data between normal and Fontan's circulations, systemic blood pressure and cardiac output in Fontan's circulation decreased to 50-70% and 30-50% of the levels in normal circulation, respectively. On the other hand, pulmonary vascular resistance increased to 2.6 times normal level after Fontan's operation. It was recognized that skeletal muscle sutured to either the right atrium or right ventricle acted as a right heart assist device when it was stimulated by burst impulse, but it was easy to fatigue during continuous stimulation. After Fontan's operation, the latissimus dorsi muscle wrapping around the left and right ventricles was stimulated by burst impulse. This muscle stimulation caused an increase of blood pressure and cardiac output to 130 and 170% of the values before stimulation, respectively. Pulmonary vascular resistance was reduced to 40% of the Fontan's circulation level.From these results it was concluded that right heart assist by electrical stimulation of pedicle skeletal muscle implanted around the heart improved hemodynamics after Fontan's operation. Further study is necessary to define adequate implantation portion of the skeletal muscle and better stimulation mode, and to make fatigue resistant muscle in order to have more effective right heart assist.

本研究旨在探讨带蒂骨骼肌辅助右心对Fontan手术后血流动力学的影响，以扩大Fontan手术的适应证。建立了实验动物长期存活的Fontan手术模型。比较正常循环和Fontan循环的血流动力学数据，Fontan循环中的体循环血压和心输出量分别降低到正常循环水平的50-70%和30-50%。Fontan手术后肺血管阻力增加到正常的2.6倍。研究发现，缝于右心房或右心室的骨骼肌在短脉冲刺激下可起到右心辅助装置的作用，但在连续刺激下容易疲劳。Fontan手术后，用短脉冲刺激包裹左右心室的背阔肌。这种肌肉刺激导致血压和心输出量分别增加到刺激前值的130%和170%。肺血管阻力降低到Fontan循环水平的40%。从这些结果可以得出结论，右心辅助通过植入心脏周围的带蒂骨骼肌的电刺激改善Fontan手术后的血流动力学。需要进一步研究来确定骨骼肌的适当植入部分和更好的刺激模式，并使肌肉具有抗疲劳性，以便更有效地进行右心辅助。