Dynamic Fontan Operation With Skeletal Muscle Conduit For Single Ventricle With Pulmonary Hypertension

骨骼肌导管动态 Fontan 手术治疗单心室肺动脉高压

• 批准号: 11671342
• 负责人: TANAKA Kei
• 金额: $ 1.92万
• 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: 1999
• 资助国家: 日本
• 起止时间: 1999 至 2000
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-11671342/
• 关键词: skeletal muscle; Fontan procedure; single ventricle; pulmonary hypertension; preconditioning; dynamiccardiomyoplasty; skeletal muscle ventricle; cardiopulmomary bypass; フオンタン手術; 広背筋; 骨格筋導管; 広背筋導管; SMV

Purpose : The purpose of this experimental study is to test the feasibility of a new surgical procedure "dynamic Fontan operation" with skeletal muscle ventricle (SMV) or linear skeletal muscle conduit constructed by the electrically paced skeletal muscle grafts for single ventricle (SV) with pulmonary hypertension (PH) to obtain a possible proxy for high risk patients for Fontan procedure. Methods : As the preliminary studies using 33 dogs, SMVs constructed with latissimus dorsi were stimulated in a mock-circulation system to test (1) the effects of electrical preconditioning on contractile properties and fatigue resistance and (2) mechanical function of intrathoracic SMV.These studies showed that (1) electrical preconditioning produced highly fatigue resistance from muscle fiber transformation and metabolic shift to aerobic metabolism, and (2) an intrathoracic SMV with a resting volume of 2ml/kg showed sufficient mechanical property as maximum SWI of 0.7±0.06gm/ml to replace total ri … More ght ventricular work. Base on these pilot studies, skeletal muscle ventricles (SMV) (n-5) and skeletal muscle conduit (n=8) constructed by a pedicled left lattissimuss dorsi (LD) flap in 13 puppies, was electrically precondtioned for 6 weeks within the left thorax. The surgical model of the single ventricle with pulmonary hypertension was made by obliteration of the right ventricular cavity with concomittent closure of the tricuspid valve and the right pulmonary artery by using a cardiopulmonary bypass (CPB). Dynamic Fontan was established by (1) an aortic homograft anastomosed between the right atrium and pulmonary artery incorporated with intra-thoracic SMV or (2) the linear contractile conduit anastomosed between the right atrium and pulmonary trunk. After the termination of CPB, skeletal muscle grafts were stimulated with a trained-pulse (25 Hz). Results : Profound right heart failure was noted without skeletal muscle graft stimulation at the presence of increased pulmonary vascular resistance (11±3.2 Wood units, 412±34% of pre CPB values), whereas conduit stimulation showed significant augmentation of the mean pulmonary flow by 68±23% and the systolic aortic pressure by 33±5% at a physiological range of CVP (13.2±0.7mmHg). Right heart function curve analysis confirmed dramatical augmentaion of right heart performance by dynamic Fontan, restoring almost normal pulmonary circulation even with pulmonary hypertension.Conclusion : Dynamic Fontan procedure may be a viable surgical option for the single ventricle with pulmonary hypertension, which can not be a Fontan candidate. Less

目的：本实验研究的目的是测试一种新的手术方式“动态Fontan手术”的可行性，该手术采用骨骼肌心室（SMV）或由电节律骨骼肌移植物构建的线性骨骼肌导管治疗单心室（SV）肺动脉高压（PH），以获得Fontan手术的高风险患者的可能替代方法。方法：以33只狗为实验对象，在模拟循环系统中刺激背阔肌构建的SMV，测试(1)电预处理对胸内SMV收缩性能和抗疲劳性能的影响；(2)力学功能。这些研究表明：(1)电预处理产生了从肌纤维转化和代谢向有氧代谢转变的高度抗疲劳性；(2)静息容积为2ml/kg的胸内SMV具有足够的力学性能，最大SWI为0.7±0.06gm/ml，可以替代总心室功。在这些初步研究的基础上，13只幼犬的骨骼肌心室（n-5）和骨骼肌导管（n=8）由带蒂的左背提拉皮瓣在左胸腔内进行了6周的电预处理。采用体外循环术（CPB）封闭右心室腔，同时关闭三尖瓣和右肺动脉，建立单心室肺动脉高压手术模型。动态Fontan是通过(1)右心房与肺动脉之间吻合的主动脉同源移植物结合胸内SMV或(2)右心房与肺动脉干之间吻合的线性收缩导管建立的。CPB终止后，用训练脉冲（25 Hz）刺激骨骼肌移植物。结果：在肺血管阻力增加（11±3.2 Wood单位，为CPB前值的412±34%）的情况下，没有骨骼肌移植刺激的患者出现了严重的右心衰，而导管刺激在CVP（13.2±0.7mmHg）的生理范围内，平均肺流量显著增加68±23%，主动脉收缩压显著增加33±5%。右心功能曲线分析证实，动态方坦能显著增强右心功能，即使肺动脉高压也能恢复几乎正常的肺循环。结论：动态Fontan手术可能是单心室肺动脉高压的一种可行的手术选择。少

项目成果

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