Dynamic cardiomyoplasty in patients
Magovern, G.J.; Park, S.B.; Kao, R.L.; Christlieb, I.Y.; Magovern, G.J.
Journal of Heart Transplantation 9(3 Pt 1): 258-263
1990
ISSN/ISBN: 0887-2570 PMID: 2355278 Document Number: 359836
Dynamic cardiomyoplasty has been used to correct cardiac defects, augment contraction of weakened myocardium, and support circulation of end-stage heart disease patients by using their own skeletal muscle after electric conditioning. Five patients, each with a history of myocardial infarction and diffused coronary artery disease, underwent the application of the left latissimus dorsi muscle over the anterolateral wall or around the ventricles. In all patients the left latissimus dorsi muscle was dissected free from all insertions with careful preservation of the thoracodorsal nerve and vessels. The freed muscle flap was internalized into the thoracic cavity with the humeral tendinous end of the muscle sutured to the periosteum of the second or third rib after subperiosteum resection of a portion of the rib. The muscle flap was used in three of the five patients for ventricular wall repair after aneurysmectomy. In the other two patients the muscle was applied over the ventricles for functional augmentation. The skeletal muscle was electrically conditioned to contain mainly fatigue-resistant muscle fibers and was stimulated to contract synchronously with the heart. All patients survived the operation, with immediate improvement of ventricular function for those who had had aneurysmectomy. A significant increase in ejection fraction was observed in three of the five patients when the pacemaker was turned on. One patient died of sudden ventricular arrhythma 2 months after the operation. The last patient is doing well at 6 weeks after operation. The first patient has been followed up for more than 3 years and continues to do well. From this limited experience, dynamic cardiomyoplasty can benefit the repair of myocardial defects and augment ventricular function without observable adverse effects.