RESUMO
The aim of this study was to investigate the influence of enhanced external counterpulsation (EECP) on the cardiac function of beagle dogs after prolonged ventricular fibrillation. Twenty-four adult male beagles were randomly divided into control and EECP groups. Ventricular fibrillation was induced in the animals for 12 min, followed by 2 min of cardiopulmonary resuscitation. They then received EECP therapy for 4 h (EECP group) or not (control group). The hemodynamics was monitored using the PiCCO2 system. Blood gas and hemorheology were assessed at baseline and at 1, 2, and 4 h after return of spontaneous circulation (ROSC). The myocardial blood flow (MBF) was quantified by 18F-flurpiridaz PET myocardial perfusion imaging at baseline and 4 h after ROSC. Survival time of the animals was recorded within 24 h. Ventricular fibrillation was successfully induced in all animals, and they achieved ROSC after cardiopulmonary resuscitation. Survival time of the control group was shorter than that of the EECP group [median of 8 h (min 8 h, max 21 h) vs median of 24 h (min 16 h, max 24 h) (Kaplan Meyer plot analysis, P=0.0152). EECP improved blood gas analysis findings and increased the coronary perfusion pressure and MBF value. EECP also improved the cardiac function of Beagles after ROSC in multiple aspects, significantly increased blood flow velocity, and decreased plasma viscosity, erythrocyte aggregation index, and hematocrit levels. EECP improved the hemodynamics of beagle dogs and increased MBF, subsequently improving cardiac function and ultimately improving the survival time of animals after ROSC.
Assuntos
Reanimação Cardiopulmonar/métodos , Contrapulsação/métodos , Hemodinâmica/fisiologia , Animais , Estudos de Casos e Controles , Modelos Animais de Doenças , Cães , Estimativa de Kaplan-Meier , MasculinoRESUMO
The aim of this study was to investigate the influence of enhanced external counterpulsation (EECP) on the cardiac function of beagle dogs after prolonged ventricular fibrillation. Twenty-four adult male beagles were randomly divided into control and EECP groups. Ventricular fibrillation was induced in the animals for 12 min, followed by 2 min of cardiopulmonary resuscitation. They then received EECP therapy for 4 h (EECP group) or not (control group). The hemodynamics was monitored using the PiCCO2 system. Blood gas and hemorheology were assessed at baseline and at 1, 2, and 4 h after return of spontaneous circulation (ROSC). The myocardial blood flow (MBF) was quantified by 18F-flurpiridaz PET myocardial perfusion imaging at baseline and 4 h after ROSC. Survival time of the animals was recorded within 24 h. Ventricular fibrillation was successfully induced in all animals, and they achieved ROSC after cardiopulmonary resuscitation. Survival time of the control group was shorter than that of the EECP group [median of 8 h (min 8 h, max 21 h) vs median of 24 h (min 16 h, max 24 h) (Kaplan Meyer plot analysis, P=0.0152). EECP improved blood gas analysis findings and increased the coronary perfusion pressure and MBF value. EECP also improved the cardiac function of Beagles after ROSC in multiple aspects, significantly increased blood flow velocity, and decreased plasma viscosity, erythrocyte aggregation index, and hematocrit levels. EECP improved the hemodynamics of beagle dogs and increased MBF, subsequently improving cardiac function and ultimately improving the survival time of animals after ROSC.
Assuntos
Animais , Masculino , Cães , Contrapulsação/métodos , Reanimação Cardiopulmonar/métodos , Hemodinâmica/fisiologia , Estudos de Casos e Controles , Modelos Animais de Doenças , Estimativa de Kaplan-MeierRESUMO
UNLABELLED: The present study is aimed at describing the short-term assessment of clinical and angiographic results in patients with acute myocardial infarction treated with rescue percutaneous transluminal coronary angioplasty (RPTCA). METHODS: We reviewed retrospectively, from January 2001 to July 2004, the interventional procedures performed in patients with coronary heart disease. From a total of 3,258 patients we selected 32 (0.98%) with acute myocardial infarction and failure of thrombolysis treatment, which were treated with RPTCA to relief the symptoms. Average age was 63 years (range 47-79), there were 24 men (75%); hypertension in 29 (90.6%); diabetes mellitus in 18 (56.3%); currently smoking 24 (75%); dyslipidemia in 11 (34.4%); unstable angina in 9 (28.1%); previous myocardial infarction in 2 (6.3%). The area related to the infarction was anterior and lateral in 14 (43.8%), anteroseptal in 6 (18.8%), postero-inferior in 5 (15.6%) with electric and hemodynamic involvement in 4 (12.5%), lateral in 1 (3.1%). Thrombolysis treatment was delivered in 3.19 hours (range 2-7 hours) with streptokinase in 19 (59.4%) and rTPA in 13 (40.6%). The evaluated serum marker was CPK-MB with the highest level of 348 +/- 240 U/L. Killip Kimball (KK) class was established as follows: KKI in 5 (15.6%), II in 16 (50%), III in 5 (15.6%), and IV in 6 (18.8%). Patients with cardiogenic shock were treated with intra-aortic balloon counter-pulsation. RESULTS: Time between symptoms and arrival to the cath lab was 11 hours (range 6-24 hours). TIMI flow was: TIMI 0 in 16 (50%). TIMI 1 in 10 (31.2%), TIMI 2 in 6 (18.8%). The number of vessels with a significant lesion was 1.9 (range 1-4). Stents were placed in 27 (84.3%) patients. Angiographic success postangioplasty was achieved in 24 (75%); there were 9 complications (28.1%), no reflow in 7 (21.8%), coronary dissection in 1 (3.1%). Six patients died (18.7%) and 4 of them (12.5%) were in cardiogenic shock. CONCLUSION: RPT-CA is a high-risk procedure, being an acceptable treatment option for patients with thrombolysis failure.
Assuntos
Angioplastia Coronária com Balão , Fibrinolíticos/uso terapêutico , Infarto do Miocárdio/terapia , Estreptoquinase/uso terapêutico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Idoso , Angioplastia Coronária com Balão/mortalidade , Angiografia Coronária , Contrapulsação/métodos , Eletrocardiografia , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco , Choque Cardiogênico/terapia , Stents , Estreptoquinase/administração & dosagem , Fatores de Tempo , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do TratamentoRESUMO
El objetivo es describir nuestra experiencia, resultados clínicos y angiográficos inmediatos en pacientes con IAM sometidos a angioplastía coronaria transluminal percutánea de rescate (ACTPR). Material y métodos: Tipo de estudio; retrospectivo, observacional, transversal y descriptivo con seguimiento a 30 días. De enero de 2001 a julio de 2004 se realizaron 3,238 procedimientos de ACTP con aplicación de stent a pacientes con diagnóstico de cardiopatía isquémica por aterosclerosis coronaria, se seleccionó a 32 pacientes que representan el 0.98%, con edad de 47 a 79 años promedio de 63, 24 (75%) del sexo masculino, con hipertensión arterial sistémica 29 (90.6%), diabetes mellitus 18 (56.3%), hipercolesterolemia 11 (34.4%), tabaquismo 24 (75%), con antecedentes de angina inestable 9 (28.1%) y con infarto miocardio previo 2 (6.3%). La localización del IAM: anterior extenso 14 (43.8%), anteroseptal en 6 (18.8%), postero-inferior en 5 (15.6%), Pl con extensión eléctrica y/o hemodinámica en VD en 4 (12.5%), lateral en 1 (3.1%). Se trombolizaron en un tiempo promedio 3.19 horas (rango 2-7) con estreptoquinasa 19 (59.4%) y con rTPA 13 (40.6%), la CPK-MB pico (U) promedio de 348 ± 240. Con Killip Kimball (KK) 1 en cinco (15.6%), II 16 (50%), III 5 (15.6%) y IV 6 (18.8%) éstos manejados con balón intraaórtico de contrapulsación. Resultados: Llevados a sala de hemodinamia en un tiempo de 6 a 24 h encontrando flujo TIMI 0 en 16 (50%), TIMI 1 en diez (31.2%), TIMI 2 en seis (18.8%), promedio de vasos enfermos de 1.9. Se implantó stent en 27 (84.3%). Éxito angiográfico post ACTP más stent TIMI 3 en 24 (75%). Complicaciones: En 9(28.1%), en 7 (21.8%) con no reflujo y en 1 (3.1%) disección de la arteria coronaria relacionada con el IAM, 6 (18.7%) que fallecieron, en 4 (12.5%) con choque cardiogénico; 3 (9.3%) la ACTPR fue fallida. Conclusión: La ACTPR es un procedimiento de alto riesgo y pese a ello es una buena alternativa de tratamiento en pacientes con trombólisis fallida.
The present study is aimed at describing the short-term assessment of clinical and angiographic results in patients with acute myocardial infarction treated with rescue percutaneous transluminal coronary angioplasty (RPTCA). Methods: We reviewed retrospectively, from January 2001 to July 2004, the interventional procedures performed in patients with coronary heart disease. From a total of 3,258 patients we selected 32 (0.98%) with acute myocardial infarction and failure of thrombolysis treatment, which were treated with RPTCA to relief the symptoms. Average age was 63 years (range 47-79), there were 24 men (75%); hypertension in 29 (90.6%); diabetes mellitus in 18 (56.3%); currently smoking 24 (75%); dyslipidemia in 11 (34.4%); unstable angina in 9 (28.1%); previous myocardial infarction in 2 (6.3%). The area related to the infarction was anterior and lateral in 14 (43.8%), anteroseptal in 6 (18.8%), postero-inferior in 5 (15.6%) with electric and hemodynamic involvement in 4 (12.5%), lateral in 1(3.1 %). Thrombolysis treatment was delivered in 3.19 hours (range 2-7 hours) with streptokinasein 19 (59.4%) and rTPA in 13 (40.6%). The evaluated serum marker was CPK-MB with the highest level of 348 ± 240 U/L. Killip Kimball (KK) class was established as follows: KKI in 5 (15.6%), II in 16 (50%), III in 5 (15.6%), and IV in 6 (18.8%). Patients with cardiogenic shock were treated with intra-aortic balloon counterpulsation. Results: Time between symptoms and arrival to the cath lab was 11 hours (range 6-24 hours). TIMI flow was: TIMI 0 in 16(50%). TIMI 1 in 10 (31.2%), TIMI 2 in 6 (18.8%). The number of vessels with a significant lesion was 1.9 (range 1-4). Stents were placed in 27 (84.3%) patients. Angiographic success post-angioplasty was achieved in 24 (75%); there were 9 complications (28.1%), no reflow in 7 (21.8%), coronary dissection in 1 (3.1%). Six patients died (18.7%) and 4 of them (12.5%) were in cardiogenic shock. Conclusion: RPT-CA is a high-risk procedure, being an acceptable treatment option for patients with thrombolysis failure.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Angioplastia Coronária com Balão , Fibrinolíticos/uso terapêutico , Infarto do Miocárdio/terapia , Estreptoquinase/uso terapêutico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Angioplastia Coronária com Balão/mortalidade , Angiografia Coronária , Contrapulsação/métodos , Eletrocardiografia , Fibrinolíticos/administração & dosagem , Infarto do Miocárdio/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco , Stents , Choque Cardiogênico/terapia , Estreptoquinase/administração & dosagem , Fatores de Tempo , Resultado do Tratamento , Ativador de Plasminogênio Tecidual/administração & dosagemRESUMO
INTRODUCTION: La contrepulsion externe (CPE) est une tech-nologie que l'on utilise le plus souvent pour traiter les patients qui présentent une angine de poitrine réfractaire au traitement médical classique et ne sont pas admissibles à une re-vascularisation, que ce soit par chirurgie de pontage ou angioplastie. La présente évalua-tion découle d'une demande formulée par un membre de l'Assemblée nationale à la suite de représentations de patients. Celui-ci de-mandait à l'Agence d'évaluation des techno-logies et des modes d'intervention en santé (AETMIS) des précisions quant à l'efficacité de la CPE et à ses possibilités d'application au Québec, le cas échéant. Cette évaluation porte principalement sur l'efficacité, l'innocuité et les coûts liés à l'utilisation de la CPE pour le traitement de l'angine chronique. Elle s'intéresse également aux données portant sur l'efficacité de cette technologie au regard d'autres maladies (comme l'insuffisance cardiaque et le diabète), sur lesquelles les informations cliniques com-mencent à s'accumuler. DESCRIPTION DE LA TECHNOLOGIE: La CPE fait appel à des brassards compressifs appliqués au niveau des membres inférieurs. Ces brassards sont gonflés avec de l'air com-primé durant la diastole (remplissage du ven-tricule) et dégonflés en début de systole (éjec-tion du sang depuis le cÅur dans la circulation générale) . Le gonflement rapide des brassards, suivi du dégonflement, aug-mente la pression aortique diastolique, la pression coronarienne de perfusion et le débit cardiaque. Les mécanismes d'action de la CPE ne sont pas encore entièrement élucidés, bien que plusieurs aient été postulés. Cette technique est le plus souvent adminis-trée dans un contexte de soins ambulatoires. Elle comporte 35 heures de traitement, soit habituellement une séance d'une heure par jour, cinq jours par semaine pendant sept se-maines. Deux compagnies manufacturières se partagent le marché de la CPE. Comme la quasi-totalité des études examinées portent sur l'EECP® (Enhanced External Counterpul-sation) de Vasomedical inc., c'est de ce sys-tème dont il sera principalement question au cours de la présente évaluation. Seul un car-diologue d'un cabinet privé montréalais offre ce traitement au Québec, et les frais sont à la charge du patient. CONCLUSION ET RECOMMANDATIONS: En raison du vieillissement de la population et des succès enregistrés dans l'amélioration de la survie des personnes atteintes d'un in-farctus du myocarde, de plus en plus de Qué-bécois seront aux prises avec une angine chronique stable réfractaire. Le statut techno-logique de la CPE ne fait pas consensus chez les experts consultés. On ne peut toutefois ignorer la convergence des résultats (la quasi-constance de l'association, son degré, son existence à travers divers plans de recherche, diverses méthodes de mesure, divers milieux d'administration, différents types de dispensa-teurs et différents groupes de patients). Celle-ci nous amène fortement à penser que les changements physiologiques et l'amélioration clinique observés après un traitement de CPE dans les études de type séries de cas et essai randomisé pourraient être reproduits chez des patients atteints d'angine chronique réfractaire dans d'autres contextes. Le fait qu'il n'y ait pas d'autre solution non effractive à la CPE pour les patients atteints d'angine chronique stable réfractaire milite également en faveur d'une certaine ouverture vis-à-vis de la CPE, mais dans un cadre d'implantation restreint et balisé. À À la lumière de toutes ces considérations, l'AETMIS estime que le ministère de la Santé et des Services sociaux devrait envisager, en collaboration avec le Réseau québécois de cardiologie tertiaire, d'acquérir un système de CPE et d'en défrayer les coûts d'acquisition et de fonctionnement. Ce système devrait être installé dans un centre hospitalier universi-taire (CHU) de cardiologie tertiaire dans le cadre d'un projet de recherche subventionné. Ce projet devrait permettre l'évaluation de l'efficacité, de l'utilité et des coûts associés à la technologie dans un contexte québécois. L'accès à la CPE devrait être réservé aux pa-tients atteints d'une angine chronique stable réfractaire selon des critères établis. Il serait indiqué que le Fonds de recherche en santé du Québec (FRSQ) et son réseau de recherche en santé cardiovasculaire considèrent l'évalua-tion de la CPE comme une priorité de recher-che. L'AETMIS pourra continuer à assurer une veille technologique sur la CPE, et ce, en collaboration avec le CHU désigné.
Assuntos
Humanos , Angina Pectoris/terapia , Doença das Coronárias/terapia , Contrapulsação/métodos , Análise Custo-Benefício/economia , Resistência a Medicamentos , Avaliação em Saúde/economia , Avaliação da Tecnologia BiomédicaRESUMO
A terapêutica de pacientes com doença coronária e com angina do peito tem sido a mesma já há muitos anos, baseando-se nos nitratos, betabloqueadores e antagonistas de cálcio. Mais recentemente, e em função do crescente número de pacientes que têm angina do peito a despeito do tratamento habitual, novos fármacos têm sido desenvolvidos, alguns em estudo de fase III, incluindo trimetazidina, ranolazina, nicorandil e ivabradina. Quando a angina do peito não é controlada com a medicação, é realizado tratamento com angioplastia e com cirurgia, mas existem indivíduos que, a despeito desses tratamentos, persistem com angina sem perspectiva de resolução de seus sintomas. Para esses pacientes desenvolveram-se alternativas, desde o "laser" intramiocárdico até terapêutica com analgesia espinal, e, mais recentemente, a terapia gênica. Esta última está em fase de desenvolvimento, mas algumas alternativas já estão sendo avaliadas em estudo de fase III.
Assuntos
Humanos , Analgesia , Angina Pectoris , Antagonistas Adrenérgicos beta/administração & dosagem , Contrapulsação/métodos , Doença das Coronárias , Revascularização Miocárdica/métodos , Terapia Tecidual Histórica , Trimetazidina , Aspirina , Lasers , Nicorandil , Fatores de TempoRESUMO
BACKGROUND: Dynamic aortomyoplasty is an alternative to heart transplantation. The goal of our study was to evaluate the benefits of aortic counterpulsation obtained using dynamic aortomyoplasty in patients with heart failure refractory to pharmacologic treatment and with contraindications to heart transplant. METHODS: In this study, we compared the pre-operative and post-operative data of 15 selected patients who underwent dynamic thoracic aortomyoplasty. In this surgical technique, the right latissimus dorsi muscle flap is wrapped around the ascending aorta. This muscle flap was electrically stimulated during diastole, following a muscle-conditioning protocol, to obtain diastolic augmentation. At 12-month follow-up, we evaluated invasively and non-invasively the hemodynamic, clinical, and functional effects of aortomyoplasty. RESULTS: When comparing pre-operative data with 12-month follow-up data, we observed a significant decrease in the number of hospitalizations (p < 0.001) and in the New York Heart Association functional class (p < 0.001), and we observed significant improvement in the walking test (p < 0.001) and in peak oxygen consumption (p < 0.05). CONCLUSIONS: Dynamic, biologic, chronic counterpulsation of the aorta using a latissimus dorsi flap (dynamic aortomyoplasty) in selected patients with severe heart failure significantly improved hemodynamic parameters, heart functional data, and clinical functional class. A larger clinical experience with a longer follow-up would be useful in evaluating this technique's clinical relevance.
Assuntos
Cardiomioplastia , Contrapulsação/métodos , Insuficiência Cardíaca/cirurgia , Idoso , Estimulação Elétrica , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Dynamic aortomyoplasty is an alternative technique to heart transplantation. The goal of our study was to evaluate the benefits of aortic counterpulsation obtained by dynamic thoracic aortomyoplasty in patients with heart failure refractory to pharmacologic treatment and contraindications to heart transplant or cardiomyoplasty. METHODS: In this study we compared preoperative and postoperative data from five out of six carefully selected patients who were treated with dynamic thoracic aortomyoplasty. This surgical technique wraps the right latissimus dorsi muscle flap around the ascending aorta. This muscle flap was electrically stimulated during diastole, following a muscle-conditioning protocol, to obtain diastolic augmentation. At the 6-month follow-up period we evaluated, invasively and noninvasively, the hemodynamic and clinical effects of aortomyoplasty. RESULTS: We observed a significant decrease in the number of hospitalizations (P = 0.01), NYHA functional class (P = 0.01), cardiothoracic ratio (P = 0.02), right ventricular diameter (P = 0.03), left atrial diameter (P = 0.04), and pulmonary artery systolic pressure (P = 0.04); and a significant increase in the 6-minute walking test (P = 0.01), cardiac index (P = 0.04), noninvasive evaluation of diastolic augmentation (P = 0.01), left ventricular shortening fraction (P = 0.01), and radioisotopic left ventricular ejection fraction (P = 0.02). We also found a nonsignificant decrease in the left ventricular diameter (P = 0.08) and wedge pressure (P = 0.19); and a nonsignificant increase in peak oxygen consumption (P = 0.13). CONCLUSIONS: Dynamic thoracic aortomyoplasty in heart failure resulted in an important improvement of hemodynamic parameters, heart functional data, and clinical functional class, when comparing preoperative data with the 6-month follow-up data.
Assuntos
Aorta Torácica/cirurgia , Contrapulsação/métodos , Insuficiência Cardíaca/terapia , Músculo Esquelético/transplante , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Aorta Torácica/diagnóstico por imagem , Cateterismo Cardíaco , Cineangiografia , Estimulação Elétrica , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica , Período Pós-Operatório , Pressão Propulsora Pulmonar , Volume Sistólico , Resultado do TratamentoRESUMO
BACKGROUND: Aortic counterpulsation, either biologic or mechanical, is a useful technique to support circulation during left ventricular dysfunction. METHODS: In this study we used an induced cardiac failure model in acute open chest sheep to compare hemodynamic improvements between thoracic and abdominal aortic counterpulsation. This was achieved with left latissimus dorsi and left hemidiaphragm muscle flaps. RESULTS: Thoracic and abdominal aortic counterpulsation in heart failure resulted in a significant improvement of hemodynamic parameters. Subendocardial viability index, defined as diastolic pressure-time index to systolic tension-time index, in thoracic and abdominal aortomyoplasty showed significant improvement (p<0.05) when cardiac assistance was performed by electrical stimulation of each muscle flap. A new counterpulsation index derived from diastolic and systolic areas beneath the aortic pressure curve was tested, obtaining a correlation coefficient with the subendocardial viability index of 0.758 (p<0.001). Values of subendocardial viability index and counterpulsation index showed minimal variability. CONCLUSIONS: Treatment of experimentally induced cardiac failure with dynamic abdominal aortic counterpulsation allows an effective hemodynamic improvement in open chest sheep. Furthermore, this diastolic arterial pressure augmentation could be evaluated through a new counterpulsation index derived from diastolic and systolic areas beneath the aortic pressure curve.
Assuntos
Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Contrapulsação/métodos , Insuficiência Cardíaca/terapia , Animais , Hemodinâmica , Músculo Esquelético/transplante , Ovinos , Retalhos CirúrgicosRESUMO
Dynamic aortomyoplasty has been the subject of experimentation for the treatment of congestive heart failure during the last few years. This method consists of diastolic counterpulsation of the ascending aorta through the stimulation of the latissimus dorsi wrapped around it. This report describes the results of aortomyoplasty in a patient with dilated cardiomyopathy resulting from Chagas' disease and contraindications for heart transplantation or cardiomyoplasty.
Assuntos
Aorta/cirurgia , Cardiomioplastia/métodos , Contrapulsação/métodos , Insuficiência Cardíaca/cirurgia , Aorta/fisiopatologia , Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Dilatada/cirurgia , Cardiomiopatia Chagásica/fisiopatologia , Cardiomiopatia Chagásica/cirurgia , Contraindicações , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologiaRESUMO
É descrita uma nova técnica para contrapulsaçao intra-aórtica, por dissecçao cirúrgica da artéria femoral, e introduçao do balao intra-aórtico através de um segmento de veia safena. A remoçao do balao evita a realizaçao de nova incisao cirúrgica, diminui as causas de obstruçao das artérias e a infecçao de ferida cirúrgica. Foi estudada a evoluçao de 18 pacientes operados.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Balão Intra-Aórtico/métodos , Contrapulsação/métodos , Artéria Femoral/cirurgia , Veia Safena/cirurgiaRESUMO
PURPOSE: To study the hemodynamic effects of latissimus dorsi dynamic pulmonaroplasty in open chest animals. METHODS: Six anesthetized mongrel dogs were subjected to diastolic counterpulsation using electrically stimulated latissimus dorsi muscle flap wrapped around the aortic and pulmonary arteries roots and gated to the surface electrocardiogram. Aortic and Pulmonanary pressures as well as cardiac output and cardiac index were measured. RESULTS: Diastolic counterpulsation resulted in a significant increase in cardiac output (from 2.35 +/- 0.26 to 2.45 +/- 0.28 l/min) (p < 0.005) and cardiac index (from 0.108 +/- 0.020 to 0.113 +/- 0.020 l/min/kg) (p < 0.05). The diastolic pulmonary arterial efficiency index showed a significant increase when latissimus dorsi stimulation was on (from 8.37 +/- 0.60 to 11.65 +/- 0.83 mmHg); (p < 0.005). CONCLUSION: Latissimus dorsi dynamic pulmonaroplasty provides an effective means of arterial counter pulsation in open chest dogs.
Assuntos
Aorta/cirurgia , Contrapulsação/métodos , Artéria Pulmonar/cirurgia , Disfunção Ventricular Direita/terapia , Animais , Pressão Sanguínea , Cães , Eletrocardiografia , Retalhos Cirúrgicos , Disfunção Ventricular Direita/fisiopatologiaRESUMO
PURPOSE: To study the hemodynamic effects of latissimus dorsi dynamic pulmonaroplasty in open chest animals. METHODS: Six anesthetized mongrel dogs were subjected to diastolic counterpulsation using electrically stimulated latissimus dorsi muscle flap wrapped around the aortic and pulmonary arteries roots and gated to the surface electrocardiogram. Aortic and Pulmonanary pressures as well as cardiac output and cardiac index were measured. RESULTS: Diastolic counterpulsation resulted in a significant increase in cardiac output (from 2.35 +/- 0.26 to 2.45 +/- 0.28 l/min) (p < 0.005) and cardiac index (from 0.108 +/- 0.020 to 0.113 +/- 0.020 l/min/kg) (p < 0.05). The diastolic pulmonary arterial efficiency index showed a significant increase when latissimus dorsi stimulation was on (from 8.37 +/- 0.60 to 11.65 +/- 0.83 mmHg); (p < 0.005). CONCLUSION: Latissimus dorsi dynamic pulmonaroplasty provides an effective means of arterial counter pulsation in open chest dogs
Objetivo - Estudar os efeitos hemodinâmicos da pulmonaroplastia dinâmica num modelo animal agudo. Métodos -Seis cães anestesiados foram tratados com contrapulsação pulmonar, obtida através de um mecanismo autólogo, utilizando-se a artéria pulmonar. Procedimento que consiste em colocar ao redor das artérias aorta e pulmonar um enxerto muscular de músculo grande dorsal, introduzido na cavidade torácica logo após sua desinserção. A estimulação do músculo foi realizada durante a diástole em forma sincronizada com o eletrocardiograma (ECG) de superfície. Foram realizadas medições hemodinâmicas de pressões pulmonares, aórticas, débito cardíaco (DC) e índice cardíaco (IC). Na avaliação da eficácia da contrapulsação diastólica pulmonar, utilizou-se o índice de eficiência arterial (IEA), que considera as áreas diastólicas e sistólicas abaixo das curvas de pressão.Resultados - Aumento do DC de 2,35 ± 0,26 para 2,45 ± 0,28 l/min (p<0,005). IC aumentou de 0,108 ± 0,020 para 0,113 ± 0,020 l/min/kg. IEA pulmonar aumentou na diástole, quando realizada a assistência, de 8,37 ± 0,60 para 11,65 ± 0,83mmHg (p<0,005). Conclusão -A eletromioestimulação do enxerto muscular de grande dorsal é um método eficiente de contrapulsação neste modelo animal de experimentação aguda
Assuntos
Animais , Cães , Aorta , Artéria Pulmonar , Contrapulsação/métodos , Disfunção Ventricular Direita/terapia , Eletrocardiografia , Disfunção Ventricular Direita/fisiopatologia , Pressão Arterial , Retalhos CirúrgicosRESUMO
BACKGROUND: Intraaortic and pulmonary artery counterpulsation are useful techniques to support circulation during either left or right ventricular dysfunction. Electrically stimulated skeletal muscles wrapped around the aorta, used as means of cardiac failure treatment, have proved to be an effective method of handling experimental left ventricular failure. In this article we report an induced cardiac failure model in acute open chest dogs and describe the hemodynamic improvement of simultaneous aortic and pulmonary artery counterpulsation. METHODS: This was achieved with a bilateral latissimus dorsi muscle flap, stimulated with a software written in C++ for Windows. Dynamic aortomyoplasty was performed using the left latissimus dorsi muscle flap around the descending aorta, and dynamic pulmonaromyoplasty was achieved wrapping the pulmonary trunk with the right latissimus dorsi muscle flap. In all animals blood pressures and cardiac output were measured after cardiac failure induced by a high-dose of propranolol hydrochloride (3 mg/kg intravenously) before and after latissimus dorsi muscle flap stimulation. RESULTS: Aortopulmonary counterpulsation resulted in a significant increase in mean aortic pressure, mean pulmonary pressure, and cardiac output. In addition, a significant decrease was observed in end-diastolic left ventricular pressure, systemic vascular resistance, and pulmonary vascular resistance. Subendocardial viability index (diastolic pressure-time index/systolic tension-time index) in aortomyoplasty and tension time index in pulmonaromyoplasty showed significant improvement when cardiac assistance was performed by electrical stimulation of both muscles (p = 0.037 and p = 0.001, respectively). CONCLUSIONS: Treatment of experimentally induced cardiac failure using aortopulmonary counterpulsation allows effective hemodynamic improvement in open-chest dogs.