Cases reported "Cardiac Output, Low"

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1/6. cardiomyoplasty does not preclude heart transplantation.

    Stimulated skeletal muscle grafts have been proposed to improve left ventricle function in patients with severe myocardial failure. In 1 particular case reported here, however, the postoperative functional improvement was only transient and disabling heart failure recurred after 9 months in spite of a vigorous latissimus muscle contraction. heart transplantation was proposed to this patient and performed successfully. Technically, the key to heart removal depends on the retrograde dissection of the ventricular cavities, starting from the right atrioventricular groove. The intraoperative observations confirmed the viability of the latissimus dorsi muscle, inefficient on a highly dilated cardiomyopathy. Histopathological examination of the latissimus dorsi muscles showed that the transformation process of the stimulated muscle was good. Thus, severe cardiac dilatation seems to be one of the limitations of cardiomyoplasty. cardiomyoplasty, when it fails, does not preclude heart transplantation. The histochemical studies confirm the electrophysiologic principle of cardiomyoplasty in humans.
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ranking = 1
keywords = cardiomyoplasty
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2/6. Bacterial infection of cardiomyostimulator abdominal pocket following cardiomyoplasty procedure: an original approach to preserve synchronous muscle stimulation.

    Dynamic cardiomyoplasty (DC) represents a new technique in therapy for refractory heart failure. So far, DC has been applied to more than 500 cases worldwide but reports on postoperative complications and related management are still lacking. We present the case of a patient suffering from refractory chronic heart failure for which the DC procedure was applied also accompanied by the complication of an infection process at the cardiomyostimulator pocket that began 2 weeks postoperatively. Following trials with several unsuccessful conservative approaches, an original procedure was developed to temporarily retain the implanted stimulation system, while at the same time maintain the synchronous contractions of the wrapped muscle. Finally, reimplantation of the pacing system was achieved with a low-risk procedure, effective cardiac assistance was preserved, and the infection process was arrested 3 years following DC.
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ranking = 2.5
keywords = cardiomyoplasty
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3/6. Anaesthesia for cardiomyoplasty.

    cardiomyoplasty is a new surgical procedure for the treatment of severe heart failure, but early mortality has been high in the preliminary experience of many centres. This report describes the anaesthetic techniques used for the first two successful cases to be performed in the UK.
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ranking = 2
keywords = cardiomyoplasty
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4/6. Pericardial "suspenders" to enhance right latissimus dorsi cardiomyoplasty.

    Right latissimus dorsi cardiomyoplasty has recently been shown to provide effective support for the chronic failing heart. A simplified technique to perform this procedure is described here. The use of the pericardial "suspenders" may avoid dangerous lifting of the heart out of its sac position, and allow a more appropriate adjustment of the wrapping tension with enhanced surgical management and potential benefits for postoperative outcome.
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ranking = 2.5
keywords = cardiomyoplasty
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5/6. Pathologic findings of latissimus dorsi muscle graft in dynamic cardiomyoplasty: clinical implications.

    BACKGROUND: We hypothesize that the integrity of the latissimus dorsi muscle graft used to wrap the heart may affect the clinical outcome of patients undergoing dynamic cardiomyoplasty. methods: By correlating the pathologic findings with their clinical course in five patients who died 1 month to 6 years after dynamic cardiomyoplasty operation, we sought to discern findings that might shed light on the pathophysiology of cardiomyoplasty. RESULTS: Of the two patients who had a limited clinical response, one had an atrophic, edematous latissimus dorsi muscle with fatty infiltration resulting from cardiac cachexia, and the other had insufficient length of latissimus dorsi muscle to cover a large heart. The remaining patients responded well clinically without signs of pump failure and died at various intervals, mostly of arrhythmias. autopsy findings included the following: (1) one patient with ischemic cardiomyopathy as the underlying disease had development of rich vascularity in the interface between the muscle wrap and the epicardium; whereas in four others with idiopathic cardiomyopathy, such evidence of collateralization was far less evident. (2) There was a variation in the skeletal muscle transformation achieved, with the fraction type I fatigue-resistant fiber in the muscle wrap ranging from 60% to 100%, in spite of the identical transformation protocol used. Such variation is believed to be genetically based. (3) In one patient, the skeletal muscle was paced to contract at 30 to 50 times/minute (2:1 ratio) for more than 5 years. Nevertheless, the pathologic specimen of the muscle wrap showed only minimal interstitial fibrosis. (4) Relatively thin muscle wrap around the heart found at autopsy could be atrophy but most likely was related to muscle transformation, which is known to reduce muscle mass and increase capillary density. (5) All skeletal muscle grafts showed geometric conformation to the shape of the epicardium and grossly looked as if they were an additional layer of the ventricular wall. Such conformation may facilitate the modulation of the ventricular remodelling process in the failing heart, as has been described both in clinical and experimental studies. CONCLUSIONS: Our findings are consistent with and support a number of mechanisms proposed for cardiomyoplasty. Thus preservation of latissimus dorsi muscle graft integrity may be important in the success of dynamic cardiomyoplasty.
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ranking = 4.5
keywords = cardiomyoplasty
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6/6. Structural alterations in the latissimus dorsi muscles in three patients more than 2 years after a cardiomyoplasty procedure.

    AIMS: The long-term effects of the use of the latissimus dorsi muscle for dynamic cardiomyoplasty were studied. Skeletal muscle fast fatiguable type II fibres are transformed to highly fatigue-resistant type I fibres in animal models, and is assumed to occur in men. However, it is not known whether this same transformation occurs in patients with chronic heart failure. methods AND RESULTS: Three patients who underwent a cardiomyoplasty procedure (pre-operative NYHA class IV) were studied. The left latissimus dorsi muscle was stimulated, according to routine clinical protocol, with 30 Hz bursts in a 2:1 ratio to cardiac activation. The patients died more than 2 years after surgery and five autopsy samples were obtained at defined places in the wrapped muscle. In the proximal part of the latissimus dorsi muscle, the type I fibres comprised 68-80% in all three patients, whereas peroperatively type I fibres comprised 17-30% indicating significant but not complete transformation. Transformation in the latissimus dorsi muscle as a whole appeared to be inhomogeneous, with type I fibres ranging from 10-80%. An extensive amount of muscle fibre appeared to be replaced by fatty tissue (10%-50%). This occurred at random and resulted in complete loss of muscle structure. A significant increase in the density of small arteries was observed in the latissimus dorsi after transformation. CONCLUSIONS: In these patients, muscle fibre type transformation was not as complete as that observed in animal experiments, and was accompanied by loss of muscle viability. The stimulation current in the latissimus dorsi muscle appeared not to be the direct cause of local tissue lipomatosis or collagen deposition.
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ranking = 3
keywords = cardiomyoplasty
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