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

目的：建立电刺激骨骼肌移植治疗复杂心脏畸形的新手术方法。方法：在12只杂种犬中，用延长的心包补片重建切除的右室游离壁，模拟发育不良的右心室(RV)的补片扩大。将长期预适应的背阔肌移植物放在补片上，并用训练好的脉冲(20赫兹)电驱动。另16只犬在体外循环(CPB)模拟单室心脏的过程中完全清除右室腔。建立改良的Fontan循环，在RA和PA之间吻合同种主动脉，并结合心包袋作为加压腔。CPB结束后，背阔肌移植物包裹心包，并用训练脉冲(20 Hz)刺激。结果：移植物起搏明显增加肺血流和压力(分别为158*21%和156*14%)，有助于恢复发育不良RV模型的正常RV功能。部分动物连续起搏7小时，无肌肉疲劳、血栓栓塞症和肌肉退行性变的迹象。结论：电刺激骨骼肌行右室成形术可以在生理预负荷下恢复正常的右室功能，为某些类型的心脏畸形提供了一种手术选择。

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.