Norbert W. Guldner, MDa, Peter Klapproth, MSca, J

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Presentation transcript:

New method for monitoring the functional state of a dynamic cardiomyoplasty Norbert W. Guldner, MDa, Peter Klapproth, MSca, J.Michael Hasenkam, MD, DMScb, Thomas Fischer, MDc, Robert Keller, MDa, Ralf Noel, VDd, Britta Keding, MTa, Elrina Joubert-Hübner, MSca, Hermann Kuppe, MD, PhDc, Hans-H. Sievers, MD, PhDa The Journal of Thoracic and Cardiovascular Surgery Volume 114, Issue 6, Pages 1097-1106 (December 1997) DOI: 10.1016/S0022-5223(97)70025-4 Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 Top, The cardiomyoplasty monitoring catheter, consisting of a saline solution filled balloon, a double-lumen catheter, and a vascular access port, is placed between the wrap of LD muscle and the base of the posterior wall of the left ventricle. Bottom, A typical recording from the DCMP catheter showing heart contractions with three DCMP contractions in 30 seconds. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 Original pressure curves obtained with the DCMP monitoring catheter in goat 4 over time on postoperative days 1, 16, 27, 37, 41, and 172. This figure shows the variation of the pressure amplitude caused by the DCMP contraction with an increase in the maximum amplitude over the first 3 weeks, followed by a decrease. The relation between the DCMP contraction and cardiac activity can also be seen. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 Original pressure curves obtained with the DCMP monitoring catheter in goat 4 over time on postoperative days 1, 16, 27, 37, 41, and 172. This figure shows the variation of the pressure amplitude caused by the DCMP contraction with an increase in the maximum amplitude over the first 3 weeks, followed by a decrease. The relation between the DCMP contraction and cardiac activity can also be seen. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 Original pressure curves obtained with the DCMP monitoring catheter in goat 4 over time on postoperative days 1, 16, 27, 37, 41, and 172. This figure shows the variation of the pressure amplitude caused by the DCMP contraction with an increase in the maximum amplitude over the first 3 weeks, followed by a decrease. The relation between the DCMP contraction and cardiac activity can also be seen. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 Original pressure curves obtained with the DCMP monitoring catheter in goat 4 over time on postoperative days 1, 16, 27, 37, 41, and 172. This figure shows the variation of the pressure amplitude caused by the DCMP contraction with an increase in the maximum amplitude over the first 3 weeks, followed by a decrease. The relation between the DCMP contraction and cardiac activity can also be seen. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 Original pressure curves obtained with the DCMP monitoring catheter in goat 4 over time on postoperative days 1, 16, 27, 37, 41, and 172. This figure shows the variation of the pressure amplitude caused by the DCMP contraction with an increase in the maximum amplitude over the first 3 weeks, followed by a decrease. The relation between the DCMP contraction and cardiac activity can also be seen. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 Original pressure curves obtained with the DCMP monitoring catheter in goat 4 over time on postoperative days 1, 16, 27, 37, 41, and 172. This figure shows the variation of the pressure amplitude caused by the DCMP contraction with an increase in the maximum amplitude over the first 3 weeks, followed by a decrease. The relation between the DCMP contraction and cardiac activity can also be seen. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 Relative maximal pressure in the monitoring catheter. The upper curve shows the relative DCMP amplitude of the pressure signals (see equation 1 in the text) induced by DCMP contractions with an increase to about 421% on postoperative day 16 and a decrease to about 67.6% on postoperative day 172. The lower curve demonstrates the relative heart amplitude as a result of cardiac motion normalized by the initial heart amplitude (see equation 2 in the text). The curve shows a decrease from 100% to 44.2%. Curves are based on calculations from pressure data from goat 4. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 Heart signals (MON) recorded via the DCMP monitoring catheter are related to the heart cycle with the use of left ventricular pressure (LVP) and left ventricular volume (LVV) measured via a conductance catheter placed in the left ventricle (unassisted beat). From the monitored signals of the heart (MON) contraction (Con), ejection (Eject.), relaxation (Rel.), and filling phases can be distinguished. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 5 A, Cross section of untrained normal LD muscle from goat 1, visualized by ATPase staining: type I fibers are dark, type IIa fibers white, and type IIb fibers gray (staining method of Brooke and Kaiser9,10; original magnification ×25). B, Muscle tissue of the DCMP from goat 1 after 6 months of electrical stimulation in 1:2 mode. Only a few type I muscle fibers are left. This finding explains the loss of the DCMP signal transferred by the monitoring catheter after postoperative week 8 (staining method of Brooke and Kaiser9,10; original magnification ×25). The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 5 A, Cross section of untrained normal LD muscle from goat 1, visualized by ATPase staining: type I fibers are dark, type IIa fibers white, and type IIb fibers gray (staining method of Brooke and Kaiser9,10; original magnification ×25). B, Muscle tissue of the DCMP from goat 1 after 6 months of electrical stimulation in 1:2 mode. Only a few type I muscle fibers are left. This finding explains the loss of the DCMP signal transferred by the monitoring catheter after postoperative week 8 (staining method of Brooke and Kaiser9,10; original magnification ×25). The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 6 A, Normal muscle fibers without cell damage from the untrained LD muscle of goat 4 (staining method of Brooke and Kaiser9,10; original magnification ×25). B, DCMP muscle tissue with solely type I fibers from goat 4 with an end-stage stimulation of 1:8 showing no muscular damage. The monitoring catheter transferred DCMP signals over 6 months up to study termination (staining method of Brooke and Kaiser9,10; original magnification ×25). The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 6 A, Normal muscle fibers without cell damage from the untrained LD muscle of goat 4 (staining method of Brooke and Kaiser9,10; original magnification ×25). B, DCMP muscle tissue with solely type I fibers from goat 4 with an end-stage stimulation of 1:8 showing no muscular damage. The monitoring catheter transferred DCMP signals over 6 months up to study termination (staining method of Brooke and Kaiser9,10; original magnification ×25). The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 7 A, Normal muscle tissue from the LD muscle from a pig (staining method of Brooke and Kaiser9,10; pH 4.35; original magnification ×40). B, Stimulated muscle tissue of the DCMP from a pig after 6 months with an end-stage synchronization mode of 1:8 showed type I fibers with minimal muscle damage. The monitoring catheter transferred clear DCMP pressure signals up to study termination at 6 months after operation (staining method of Brooke and Kaiser9,10; pH 4.35; original magnification ×40). The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 7 A, Normal muscle tissue from the LD muscle from a pig (staining method of Brooke and Kaiser9,10; pH 4.35; original magnification ×40). B, Stimulated muscle tissue of the DCMP from a pig after 6 months with an end-stage synchronization mode of 1:8 showed type I fibers with minimal muscle damage. The monitoring catheter transferred clear DCMP pressure signals up to study termination at 6 months after operation (staining method of Brooke and Kaiser9,10; pH 4.35; original magnification ×40). The Journal of Thoracic and Cardiovascular Surgery 1997 114, 1097-1106DOI: (10.1016/S0022-5223(97)70025-4) Copyright © 1997 Mosby, Inc. Terms and Conditions