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  • 1
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 11 (1996), S. 0 
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract Background: Autologous muscle has the potential of generating power for cardiac assistance. Problems with muscle fatigue have been overcome by the development of successful protocols of electrical conditioning and by allowing a recovery interval after the initial harvest. Methods: Our laboratory has pursued research with latissimus dorsi muscle pouches, which we term skeletal muscle ventricles (SMVs). By allowing several weeks for a “vascular delay” interval and then electrically conditioning the muscle, these pouches can be connected to the circulation and stimulated to assist the heart. Results: These pouches have been developed and tested in the canine model in numerous configurations, achieving survival beyond 3 years. Conclusions: Although still experimental, SMVs may have the potential of becoming a viable alternative for the future treatment of patients with end-stage heart failure and with infants with certain congenital anomalies.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A right coronary artery originating from the left coronary sinus and traversing anteriorly is thought to be one of the contraindications for a Konno aortoventriculoplasty in congenital aortic stenosis because this procedure necessitates incision of the right ventricular outflow tract. The case of a 5-year-old girl with congenital aortic stenosis associated with a single coronary artery, successfully treated surgically by the Konno procedure and right coronary artery reimplantation, is reported. Preoperatively there was a pressure gradient between the left ventricle and the ascending aorta of 109 mmHg, which disappeared postoperatively. A postoperative angiography showed a patent right coronary artery.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 6 (1991), S. 0 
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract For skeletal muscle ventricles (SMVs) to be applied clinically, it is likely that they will have to be placed within the chest. Ease of subsequent connection to the circulation, and avoidance of significant lung compression, are factors that could influence SMV size and shape in a way that may prejudice their ability to pump effectively at physiological preloads. In five dogs, specially designed SMVs were constructed from the latissimus dorsi muscle, and placed in the apex of the left hemithorax. After a 3-week delay, the muscle was preconditioned electrically by 2-Hz continuous stimulation for 6 weeks. At a later thoracotomy, this positioning of SMVs permitted easy surgical access to the heart and great vessels. SMVs were then connected to a mock circulation device for functional evaluation. As right-sided pumps, at a preload of 10 mmHg, SMVs generated a stroke volume (SV) and stroke work (SW) exceeding that of the native right ventricle (SV = 8.9 ± 0.8 vs 7.9 ± 0.6 mL; SW = 0.44 ± 0.03 vs 0.20 ergs x 106). As left-sided pumps, also at a preload of 10 mmHg, SMV SV, and SW was roughly half that of the left ventricle (SV = 3.7 ± 0.2 vs 7.9 ± 0.6 mL; SW = 0.29 ± 0.03 vs 0.57 ± 0.05 ergs x 106). SMVs may conveniently be positioned inside the chest, where they have the potential to function as left or right heart assist devices.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract In previous studies, we have shown that canine skeletal muscle ventricles (SMVs) of various designs could develop stroke work intermediate between that of the canine left and right ventricle. We have subsequently reported that SMVs could be used as aortic diastolic Counterpulsators. In some animals the SMVs pumped blood effectively for several weeks. Thromboembolism, however, caused renal failure, which was responsible for the demise of the longest surviving animals. More recently, we have studied a group of 15 dogs that had skeletal muscle ventricles constructed from their latissimus dorsi muscle and lined with autogenously derived tissues, either pleura, pericardium or fibrous tissue induced by a Teflon mandrel. We now report on one of those animals, that has survived more than 1 year. She remains active and in apparent good health with no clinical evidence of thromboemboli. Her SMV continues to generate effective aortic diastolic counterpulsation.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 10 (1995), S. 0 
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In five dogs, skeletal muscle ventricles (SMVs) were constructed from the latissimus dorsi muscle, and placed within the thoracic cavity. After a 3-week delay period, SMVs were electrically preconditioned with 2-Hz continuous stimulation for 6 weeks. At a second procedure, SMVs were connected to a mock-circulation system, and performance was evaluated according to pressure-volume relationships at three different SMV contraction rates (33, 54, and 97 per min) and three stimulation protocols (25, 43, and 85 Hz) under varying loading conditions. Under appropriate conditions of afterload, the end-diastolic pressure-volume relation of SMVs was comparable with that of the cardiac ventricles, although SMVs were less compliant. At higher burst stimulation frequencies, SMV compliance was increased. Compliance was not affected by varying the rate of SMV contraction. End-systolic elastance, a reflection of contractility, appeared to be constant for each SMV, in contrast to cardiac ventricles, and was not influenced by changes in burst stimulation frequency or contraction rate. In this study, SMVs were capable of a level of stroke work 180% of that of the native right ventricle (RV) at rest (0.397 ± 0.047 × 106 ergs) and 37% of that of the left ventricle (LV) at rest (0.298 ± 0.61 × 106 ergs), at 33 contractions per minute (CPM), 25-Hz burst frequency, and physiological preload, but this level could not be sustained at higher contraction rates. Nevertheless, power output (SMV stroke work x contraction rate) was maximal at 97 CPM. These findings demonstrate important function differences between pumping chambers constructed from conditioned skeletal muscle, and those composed of cardiac muscle, which must be considered when using skeletal muscle ventricles for cardiac support or replacement.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    350 Main Street , Malden , MA 02148-5020 , USA and 9600 Garsington Road , Oxford OX4 2XG , England . : Blackwell Science Inc
    Journal of cardiac surgery 20 (2005), S. 0 
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract  Background and aim of the study: Treatment for hypertrophic obstructive cardiomyopathy (HOCM) has been reported; however, there has been no report on the characteristics of medication-responsive and -refractory hypertrophic obstructive cardiomyopathy (HOCM). Using the classification of systolic anterior movement (SAM) which has been previously reported, we tried to identify the characteristics and use them to treat HOCM appropriately. Methods: The clinical, echocardiographic, catheterization, and surgical data of 29 hospitalized patients with HOCM during 1980 to 1999 were analyzed retrospectively. We classified SAM in all patients by echocardiography. Ninteen patients improved with medical treatment (medical group), and 10 patients underwent surgical treatment because of ineffectiveness of medication (surgical group). We studied the relation between types of SAM and medical/surgical groups, and examined the relation between types of SAM and the surgical methods. Results: Type I SAM was significantly more frequent in the medical group, while type II SAM was more frequent in the surgical group (p = 0.047). Patients in the surgical group underwent mitral valve replacement (MVR), myectomy, or a combination of MVR and myectomy. Left ventricular outflow gradient (LVOG) of over 100 mmHg was recognized in almost all patients with type II SAM. Conclusions: It was suggested that patients with medication-responsive HOCM tended to have type I SAM and those with refractory HOCM tended to have type II SAM. We consider that in type I SAM, if the position of the papillary muscles changed with medication or myectomy, shift of the chordae and type I SAM were reduced or disappeared. However, in type II SAM, even if the position of the papillary muscles changed, SAM did not disappear because lifting of the mitral leaflets remained. It is therefore suggested that patients with type II SAM should undergo at least MVR.
    Type of Medium: Electronic Resource
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