Cases reported "Cardiomyopathy, Dilated"

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1/11. Dynamic cardiomyoplasty in patients with end-stage heart failure: anaesthetic considerations.

    Dynamic cardiomyoplasty is used increasingly for patients with chronic heart failure, with approximately 500 cases having been performed. The latissimus dorsi muscle is prepared maintaining its vascular supply and the muscle flap is wrapped around the heart and connected to a cardiomyostimulator. The muscle is later stimulated synchronously with ventricular systole to augment the heart. Our experience of 22 patients with chronic heart failure (NYHA III-IV) undergoing dynamic cardiomyoplasty is described from the anaesthetist's point of view. Two patients are reported as case reports. The challenge is to manage patients with severely impaired left ventricular function, who do not obtain immediate benefit from the operation. Our experience supports the importance of early use of inotropic agents.
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ranking = 1
keywords = cardiomyoplasty, dynamic cardiomyoplasty
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2/11. Dynamic cardiomyoplasty as a biomechanic bridge to heart transplantation.

    We report a heart transplantation that was done 4 years after a dynamic cardiomyoplasty operation. The patient was a 42-year-old man. Radionucleide ventriculography with technetium 99 m revealed an ejection fraction of 18%. In July 1997 he had undergone a dynamic cardiomyoplasty operation. At the first postoperative month the left ventricular ejection fraction was 35%. In September 2000 he presented with heart failure symptoms. In May 2001 he had undergone heart transplantation. Postoperative course was uneventful. The failure of cardiomyoplasty was probably caused by degeneration of the latissimus dorsi muscle. In this case we have learned that muscle viability is lost within 4 years after dynamic cardiomyoplasty and heart transplantation is still an option for those patients.
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ranking = 1.5035545988136
keywords = cardiomyoplasty, dynamic cardiomyoplasty
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3/11. 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 = 0.29928908023728
keywords = cardiomyoplasty
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4/11. Right latissimus dorsi cardiomyoplasty for left ventricular failure.

    Recent experimental studies have shown that cardiomyoplasty using the right latissimus dorsi provides excellent hemodynamic augmentation. Based on these experimental findings, this procedure was performed in a 40-year-old man with a dilated cardiomyopathy after a large myocardial infarction. The patient tolerated the procedure well and has had marked functional improvement. Examination 6 months after operation demonstrated decreases in right atrial pressure, pulmonary capillary wedge pressure, and left ventricular end-diastolic volume. In addition, increases were noted in cardiac output, stroke volume, left ventricular stroke-work, right ventricular ejection fraction, and left ventricular ejection fraction. Because of this promising clinical result, we have started a series of right latissimus dorsi cardiomyoplasties for left ventricular failure.
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ranking = 0.7482227005932
keywords = cardiomyoplasty
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5/11. Pathophysiology of dynamic cardiomyoplasty: a clinico-pathological case study.

    A 58-year-old man with end-stage ischemic cardiomyopathy underwent dynamic cardiomyoplasty. "On" and "off" studies with the cardiac assist device failed to show any significant hemodynamic changes despite improvement in functional status. The patient's late postoperative course was complicated by two episodes of acute pulmonary edema followed by cardiac arrest. These events were precipitated by ventricular tachycardia. The last episode led to myocardial infarction requiring diastolic counterpulsation and inotropic support. He died 4 1/2 months following the cardiomyoplasty. Postmortem findings revealed an anterior left ventricular infarct with aneurysm. There was fusion of skeletal muscle to the epicardium with minimal fibrosis and atrophy. The latissimus dorsi (LD) flap was viable, but myofibrillar ATPase stain revealed incomplete transformation. Several clinical observations have emerged from the early experience with dynamic cardiomyoplasty: (1) Important arrhythmias and cardiac arrest compromise the vascular supply and thus power of the muscular flap; (2) Resting ejection fraction does not correlate with exercise tolerance, therefore, other parameters must be sought to explain improved functional status; (3) Uniform muscle transformation in humans may be unpredictable with current clinical stimulation protocols. The conformation of LD to the epicardium underscores a potential remodeling phenomenon which may ultimately spare the diseased myocardium by altering its oxygen supply/demand ratio and thus the natural history.
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ranking = 1.6603083365594
keywords = cardiomyoplasty, dynamic cardiomyoplasty
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6/11. Synchronously stimulated skeletal muscle graft for left ventricular assistance. Case report.

    A 56-year-old man with chronic dilatation of the heart caused by cardiomyopathy (new york Heart association functional class IV) was selected for cardiomyoplasty. The procedure was divided into two separate stages. In stage I the latissimus dorsi muscle was prepared for progressive stimulation. For this purpose two pacing leads were attached to the muscle, one at the proximal and the other at the distal end, and connected to a pulse-train generator, which was placed subcutaneously. A stimulation protocol was initiated in which the requirements of the latissimus dorsi muscle were periodically increased. In stage II the latissimus dorsi muscle was dissected to make a pedicle graft, which was introduced into the thorax and wrapped around the left ventricle. Pacing electrodes were sewn onto the pedicle graft in the same fashion as in stage I. Two sensing electrodes were fixed to the epicardium of the right ventricle, and the four leads were connected to a double-chambered pacemaker. Twelve days later, the pacemaker was programmed to a bipolar mode, VAT, and the latissimus dorsi muscle graft was synchronously stimulated in a 1:1 assist mode. The patient's status improved to new york Heart association functional class II. Echocardiographic studies showed better contraction of the posterior wall of the left ventricle, as well as reduction in its diameters. Radioisotopic studies demonstrated a significant improvement in hemodynamic parameters. cardiomyoplasty seems to be an alternative in those patients with severe cardiac insufficiency caused by cardiac dilation owing to cardiomyopathy.
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ranking = 0.14964454011864
keywords = cardiomyoplasty
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7/11. Right latissimus dorsi cardiomyoplasty in diaphragm eventration and cardiac malposition.

    cardiomyoplasty recently has been introduced as a surgical therapy for long-lasting cardiac dysfunction in selected patients. We report the case of a patient affected by chronic heart failure, unresponsive to maximal medical therapy, with concomitant posttraumatic injury of the left phrenic nerve, left diaphragm eventration, and cardiac malposition (right displacement). In view of the progressive deterioration of the cardiac function, cardiomyoplasty was recommended, and the right latissimus dorsi muscle was used to perform the wrapping procedure. A 6-month follow-up showed significant functional, as well as hemodynamic, improvements in addition to a reduction in medical therapy.
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ranking = 0.7482227005932
keywords = cardiomyoplasty
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8/11. Reverse remodeling from cardiomyoplasty in human heart failure. External constraint versus active assist.

    BACKGROUND: cardiomyoplasty (CM) is a novel surgical therapy for dilated cardiomyopathy. In this procedure, the latissimus dorsi muscle is wrapped around the heart and chronically paced synchronously with ventricular systole. While studies have found symptomatic improvement from this therapy, the mechanisms by which CM confers benefit remain uncertain. This study sought to better define these mechanisms by means of serial pressure-volume relation analysis. methods AND RESULTS: Serial pressure-volume studies were performed by the conductance catheter method in three patients (total to date) with dilated cardiomyopathy (new york Heart association class III) who underwent CM. Data were measured at baseline (before surgery) and at 6 and 12 months after CM. Chronic left ventricular (LV) systolic and diastolic changes induced by CM were evaluated with the stimulator in its stable pacing mode (every other beat) and after temporarily suspending pacing. CM-stimulated beats were compared with pacing-off beats to evaluate active systolic assist effects of CM. In each patient, CM resulted in a chronic lowering of cardiac end-diastolic volume and an increased ejection fraction. Most notably, the end-systolic pressure-volume relation shifted leftward, consistent with reversal of chronic chamber remodeling. In contrast, the diastolic pressure-volume relation was minimally altered, and the loops shifted down along the same baseline relation. These marked chronic changes in LV function measurable with CM stimulation off contrasted to only minor acute effects observed when the muscle wrap was activated. This suggests that the benefit of CM derived less from active systolic assist than from remodeling, perhaps because of an external elastic constraint. CONCLUSIONS: These data, while limited to a small number of patients, suggest that CM can reverse remodeling of the dilated failing heart. While systolic squeezing assist effects of CM may play a role in some patients, our study found that this was not required to achieve substantial benefits from the procedure. We speculate that CM may act more passively, like an elastic girdle around the heart, to help reverse chamber remodeling.
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ranking = 0.59857816047456
keywords = cardiomyoplasty
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9/11. Optimizing "delay period" for burst stimulation in dynamic cardiomyoplasty.

    Hemodynamic evidence of systolic assist after dynamic cardiomyoplasty remains inconsistent. One of the relevant factors may be how the burst stimulator is programmed. In 3 patients who underwent cardiomyoplasty for idiopathic dilated cardiomyopathy, we examined the modes used to determine the delay period between the R-wave sensing and the onset of burst stimulation during cardiac systole. These modes include the fixed time mode, the valve-synchronized mode, and the flow-optimized mode. The rationale for choosing these modes and the benefits conferred by each are discussed.
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ranking = 1.4085310371526
keywords = cardiomyoplasty, dynamic cardiomyoplasty
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10/11. 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 = 2.0617301760849
keywords = cardiomyoplasty, dynamic cardiomyoplasty
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