Paced Latissimus Dorsi Used for Dynamic Cardiomyoplasty of Left Ventricular Aneurysms

Magovern, George J.; Heckler, Fredrick R.; Park, Sang B.; Christlieb, Ignacio Y.; Kao, Race L.; Benckart, Daniel H.; Tullis, Gene; Rozar, Ed; Liebler, George A.; Burkholder, John A.; Maher, Thomas D.

doi:10.1016/s0003-4975(10)63797-6

Cited by 47 publications

(5 citation statements)

References 18 publications

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“…In these experiments ®bre type composition was not determined but it is likely that the ®bre types shifted towards more oxidative and less fatiguable ones. 54 Citrate synthase activity in muscle tissue The muscle citrate synthase (CS) activity was measured as an indicator of the capacity of mitochondrial oxidation (Krebs Cycle). The CS activity was determined in biopsies taken before and after 3 and 6 months and after 1 year of training.…”

Section: Fibre Types Mhc Analysis On Homogenatesmentioning

confidence: 99%

Long term adaptation to electrically induced cycle training in severe spinal cord injured individuals

et al. 1997

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Spinal cord injured (SCI) individuals most often contract their injury at a young age and are deemed to a life of more or less physical inactivity. In addition to the primary implications of the SCI, severe SCI individuals are stigmatized by conditions related to their physically inactive lifestyle. It is unknown if these inactivity related conditions are potentially reversible and the aim of the present study was, therefore, to examine the e ect of exercise on SCI individuals. Ten such individuals (six with tetraplegia and four with paraplegia; age 27 ± 45 years; time since injury 3 ± 23 years) were exercise trained for 1 year using an electrically induced computerized feedback controlled cycle ergometer. They trained for up to three times a week (mean 2.3 times), 30 min on each occasion. The gluteal, hamstring and quadriceps muscles were stimulated via electrodes placed on the skin over their motor points. During the ®rst training bouts, a substantial variation in performance was seen between the subjects. A majority of them were capable of performing 30 min of exercise in the ®rst bout; however, two individuals were only able to perform a few minutes of exercise. After training for 1 year all of the subjects were able to perform 30 min of continuous training and the work output had increased from 4+1 (mean+SE) to 17+2 Kilo Joules per training bout (P50.05). The maximal oxygen uptake during electrically induced exercise increased from 1.20+0.08 litres per minute measured after a few weeks habituation to the exercise to 1.43+0.09 litres per minute after training for 1 year (P50.05).Magnetic resonance cross sectional images of the thigh were performed to estimate muscle mass and an increase of 12% (mean, P50.05) was seen in response to 1 year of training. In biopsies taken before exercise various degrees of atrophy were observed in the individual muscle ®bres, a phenomenon that was partially normalized in all subjects after training.The ®bre type distribution in skeletal muscles is known to shift towards type IIB ®bres (fast twitch, fast fatiguable, glycolytic ®bres) within the ®rst 2 years after the spinal cord injury. The muscle in the present investigation contained of 63% myosin heavy chain (MHC) isoform IIB, 33% MHC isoform IIA (fast twitch, fatigue resistant) and less than 5% MHC isoform I (slow twitch) before training. A shift towards more fatigue resistant contractile proteins was found after 1 year of training. The percentage of MHC isoform IIA increased to 61% of all contractile protein and a corresponding decrease to 32% was seen in the fast fatiguable MHC isoform IIB, whereas MHC isoform I only comprised 7% of the total amount of MHC. This shift was accompanied by a doubling of the enzymatic activity of citrate synthase, as an indicator of mitochondrial oxidative capacity.It is concluded that inactivity-associated changes in exercise performance capacity and skeletal muscle occurring in SCI individuals after injury are reversible, even up to over 20 years after the injury. It follows that electricall...

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Section: Fibre Types Mhc Analysis On Homogenatesmentioning

confidence: 99%

Long term adaptation to electrically induced cycle training in severe spinal cord injured individuals

et al. 1997

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“…Synchronously stimulated latissimus dorsi cardiomyo plasty has been performed for reinforcement or substitu tion of the ventricular wall in patients with dilated cardio myopathy [6,12], myocardial infarction [3,5] and after resection of a large aneurysm or an extensive ventricular tumour [ 1,13]. Preclinical animal research work and clin ical studies have shown that dynamic cardiomyoplasty acts in two ways: by improving ventricular contraction and by limiting cardiac dilatation [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Left Ventricular Function by Equilibrium-Gated Angiography before and following Latissimus dorsi Cardiomyoplasty in Dilated Cardiomyopathy

Fránquiz¹,

Cabrera²,

Dorticós³

et al. 1992

Am J Noninvas Cardiol

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Latissimus dorsi cardiomyoplasty was performed in 8 patients with dilated cardiomyopathy, normal coronary arteries and functional mitral regurgitation graded as mild or moderate. Patients were studied by equilibrium-gated angiography 1 week before operation and 4 months later. The functional mitral regurgitation was assessed by the ventricular amplitude ratio (VAR) derived from the Fourier amplitude image. One patient died of ventricular arrhythmia 5 months following operation. In the other 7 patients the clinical status improved from the New York Heart Association functional class III or IV to the functional class I or II. The left ventricular ejection fraction (EF) changed from 25 ± 7 to 26 ± 6%. The postoperative end-diastolic volume index was 78 ± 11 % of the preoperative value, and the VAR decreased from 2.01 ± 0.54 to 1.49 ± 0.59 (p < 0.005). Our results suggest that in patients with severely depressed myocardial contractility the main short-term effect of dynamic cardiomyoplasty should be the reduction in the left ventricular diameters. Secondary to this effect, the functional mitral regurgitation would be reduced and the cardiac performance improved, although the global EF would not be modified.

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“…Such branching has never been previously reported. Division into three branches without particular specification of its topography is reported to occur in 2% [12], 6% [8], and 0% [7] of the most significant available series. Currently, three main hilum branching patterns can be emphasized : firstly classically described division into two main branches (33%), secondly division into three vessels, one being a recurrent artery (47%), and thirdly branching into three main branches (20%).…”

Section: Commentsmentioning

confidence: 99%

Anatomical rationale for use of the latissimus dorsi flap during the cardiomyoplasty operation

et al. 1992

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Summary.The cardiomyoplasty procedure involves the use of a transformed skeletal muscle to augment cardiac pump function or to substitute for the heart after parietal resection. This study of the intramuscular vascularization of latissimus dorsi was carried out in order to establish the relationship between the dominant thoracodorsal blood supply and the distal supply issued from the intercostal and lumbar arteries. This data is mandatory for the safe manipulation of the muscle flap during cardiomyoplasty. Thirty human latissimus dorsi flaps were carefully studied. We confirmed anatomically as well as angiographically previous macroscopic anatomical reports, as well as the constancy of the neurovascular pedicle. Three principal branching patterns were observed for the thoracodorsal artery. The thoracodorsal artery divides into three main tributaries in 20/30 (67%), and into two tributaries in 10/30 (33%) of the flaps observed. When three tributaries were observed, one of them was a small recurrent artery for the proximal third of the latissimus dorsi (14/20, 70%). Thus the distal vascularization is actually dependant on three principals in 6/30 (20%) and two principals in 24/30 (80%). From these two or three principals emerge several subsequent longitudinal branches (5 to 9) that have a straight course until their distal anastomoses with segmental arterial pedicles issued from intercostal and lumbar arteries. The latter ligation can thus occur without ischemic damage to the medial and distal aspect of the flap. This study emphasizes that, due to macroscopic anatomic features and systematic intramuscular vascular distribution, the latissimus dorsi is probably the most suitable muscle for the purpose of cardiomyoplasty.Résumé. Le concept de cardiomyoplastie s'articule sur l'utilisation d'un muscle squelettique transformé, pour augmenter la fonction de pompe dévolue au myocarde, ou pour se substituer à celui-ci après une résection pariétale. La présente étude anatomique, étudiant la distribution vasculaire intramusculaire du m. grand dorsal, a été réalisée pour apprécier la distribution intramusculaire fine, ainsi que les relations existant entre l'apport thoraco-dorsal proximal prédominant et les deux sources d'apport vasculaire périphérique issues des artères intercostales et lombaires. Cette information est indispensable pour permettre une manipulation rigoureuse du muscle lors de la cardiomyoplastie. Trente muscles grands dorsaux ont été soigneusement étudiés. Nous avons confirmé les données macroscopiques déjà publiées, ainsi que la constance du pédicule thoraco-dorsal. Trois modes principaux de division au niveau du hile ont été reconnus. L'artère thoraco-dorsale se divise en trois branches principales dans 20/30 (67%) des cas, et en deux branches principales dans 10/30 (33%) des cas. Quand trois branches sont observées, l'une d'entre elles est une petite branche récurrente pour la portion proximale du muscle dans 14/20 (70%) des cas. En conséquence, la vascularisation distale est en réalité dépendante de tro...

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Paced Latissimus Dorsi Used for Dynamic Cardiomyoplasty of Left Ventricular Aneurysms

Cited by 47 publications

References 18 publications

Long term adaptation to electrically induced cycle training in severe spinal cord injured individuals

Long term adaptation to electrically induced cycle training in severe spinal cord injured individuals

Assessment of Left Ventricular Function by Equilibrium-Gated Angiography before and following Latissimus dorsi Cardiomyoplasty in Dilated Cardiomyopathy

Anatomical rationale for use of the latissimus dorsi flap during the cardiomyoplasty operation

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