Rhythmic and Electrophysiological Study after Dynamic Cardiomyoplasty

in Pacing & Clinical Electrophysiology (1995), 18(5, Pt 1), 965-72

To question the possible proarrhythmic effects of cardiomyoplasty (CMP), six adult goats were submitted to rhythmic and electrophysiological (EP) study 15 days before and 8 months after a posteroanterior ... [more ▼]

To question the possible proarrhythmic effects of cardiomyoplasty (CMP), six adult goats were submitted to rhythmic and electrophysiological (EP) study 15 days before and 8 months after a posteroanterior clockwise CMP procedure using Medtronic Cardiomyostimulator (CMS) (SP1005) and electrodes (SP5528) and completion of a progressive stimulation protocol. Pre and postoperative screening included a surface ECG, 24-hour Holter monitoring, high amplitude and filtered QRS averaging, and invasive EP study performed in the postoperative period with the CMS "ON" and "OFF." One-hour Holter recording with desynchronization of the CMS was obtained. Comparison of pre and postoperative ECG and rhythmic data showed no significant difference. High amplitude QRS averaging did not evidence meeting the usual criteria of late potentials. EP values were stable in both conditions and the aggressive EP program did not show evidence of increased susceptibility to arrhythmias. Asynchronous cardiomyostimulation did not induce arrhythmias. Our data strongly suggest that provided meticulous surgical technique is used, CMP does not significantly interfere with the electrical characteristics of the normal goat heart. The procedure, despite the disturbances it provokes, does not seem to be arrhythmogenic. The function of the CMS was always appropriate, even under stressful EP conditions. [less ▲]

Surgical Technique for Reinforcement Cardiomyoplasty

in Acta Chirurgica Belgica (1995), 95(6), 271-4

The current technique for reinforcement cardiomyoplasty in man is detailed. The authors emphasize the critical points that determine the perfect execution of this operation. This innovative surgical ... [more ▼]

The current technique for reinforcement cardiomyoplasty in man is detailed. The authors emphasize the critical points that determine the perfect execution of this operation. This innovative surgical approach to heart failure is continuously evolving and, therefore, may be subject to improvement. The major principles however remain valuable. [less ▲]

La classification fonctionnelle des dysfonctions de la valvule mitrale selon Carpentier

in Revue Médicale de Liège (1995), 50(7), 292-4

Pour aborder le traitement chirurgical de la valvule mitrale autrement, c'est-à-dire par une réparation valvulaire comme alternative raisonnable au remplacement sytématique, il faut recourir à une ... [more ▼]

Pour aborder le traitement chirurgical de la valvule mitrale autrement, c'est-à-dire par une réparation valvulaire comme alternative raisonnable au remplacement sytématique, il faut recourir à une classfication fonctionnelle des dysfonctions mitrales. Cette classification, établie par Carpentier (1, 2) regroupe les dysfonctions valvulaire mitrales en trois rubriques : a) le type caractérisé par des mouvements valvulaires normaux, b) le type 2, équivalent au prolapsus valvulaire, c) le type 3, correspondant à la restriction des mouvements valvulaires. Cette approche nouvelle postule, en outre, qu'une affection valvulaire n'est parfaitement définie que lorsqu'on en connaît l'étiologie, les lésions et les dysfonctions. L'utilisation de cette méthode analytique (qui a l'avantage de la simplicité et de la clarté) permet au chirurgien de réparer la valvule mitrale en adaptant à chaque dysfonction une correction appropriée et, par l'application de règles, d'obtenir des résultats reproductibles (3-6). [less ▲]

L'obstruction de la chambre de chasse du ventricule gauche (LVOTO-SAM) après chirurgie réparatrice de la valvule mitrale

in Revue Médicale de Liège (1995), 50(7), 305-7

Technique for Ventricular Wrapping in Experimental Dynamic Cardiomyoplasty

in Acta Chirurgica Belgica (1994), 94(5, Sep-Oct), 266-71

Cardiomyoplasty is a wrapping of an electrostimulated latissimus dorsi muscle flap around the heart for substitution and/or reinforcement. The surgical technique for reproducible cardiomyoplasties in the ... [more ▼]

Cardiomyoplasty is a wrapping of an electrostimulated latissimus dorsi muscle flap around the heart for substitution and/or reinforcement. The surgical technique for reproducible cardiomyoplasties in the goat model is presented. The methods combine the direction of wrapping (clockwise, counter-clockwise) and the orientation of muscle fibers. A cardiomyoplasty model using right and left latissimus dorsi or left latissimus dorsi and pectoralis major as well as a split muscle technique are illustrated. [less ▲]

Anatomical Rationale for Use of the Latissimus Dorsi Flap During the Cardiomyoplasty Operation

in Surgical & Radiologic Anatomy [=SRA] (1992), 14(1), 5-10

The cardiomyoplasty procedure involves the use of a transformed skeletal muscle to augment cardiac pump function or to substitute for the heart after parietal resection. This study of the intramuscular ... [more ▼]

The cardiomyoplasty procedure involves the use of a transformed skeletal muscle to augment cardiac pump function or to substitute for the heart after parietal resection. This study of the intramuscular vascularization of latissimus dorsi was carried out in order to establish the relationship between the dominant thoracodorsal blood supply and the distal supply issued from the intercostal and lumbar arteries. This data is mandatory for the safe manipulation of the muscle flap during cardiomyoplasty. Thirty human latissimus dorsi flaps were carefully studied. We confirmed anatomically as well as angiographically previous macroscopic anatomical reports, as well as the constancy of the neurovascular pedicle. Three principal branching patterns were observed for the thoracodorsal artery. The thoracodorsal artery divides into three main tributaries in 20/30 (67%), and into two tributaries in 10/30 (33%) of the flaps observed. When three tributaries were observed, one of them was a small recurrent artery for the proximal third of the latissimus dorsi (14/20, 70%). Thus the distal vascularization is actually dependent on three principals in 6/30 (20%) and two principals in 24/30 (80%). From these two or three principals emerge several subsequent longitudinal branches (5 to 9) that have a straight course until their distal anastomoses with segmental arterial pedicles issued from intercostal and lumbar arteries. The latter ligation can thus occur without ischemic damage to the medial and distal aspect of the flap. This study emphasizes that, due to macroscopic anatomic features and systematic intramuscular vascular distribution, the latissimus dorsi is probably the most suitable muscle for the purpose of cardiomyoplasty. [less ▲]

La cardiomyoplastie

in Revue Médicale de Liège (1992), 47(3), 140-4

Surgical Management of Left Atrial Myxoma

in Acta Chirurgica Belgica (1991), 91(1), 27-31

Although rare, left atrial myxoma is an entity from anatomopathological and clinical aspects. Seven cases of left atrial myxoma operated on the last ten years were reviewed. We also report a rare ... [more ▼]

Although rare, left atrial myxoma is an entity from anatomopathological and clinical aspects. Seven cases of left atrial myxoma operated on the last ten years were reviewed. We also report a rare presentation of right atrial myxoma, where the tumor was responsible of a dramatic hemodynamic shock due to right ventricular inflow obstruction. Six patients were female, with a mean age of 53 years. All but one consulted for exertional dyspnea of recent onset. Two patients with left atrial myxoma and the patient with right atrial myxoma had experienced embolism. Five patients had systemic symptoms. Echocardiography was the most performant diagnostic procedure. All but the patient with right atrial myxoma were operated by the left atrial access. The mitral valve was replaced in two patients. The histological aspect of this benign tumor is illustrated but the lack of frank border between the tumor and the myocardium is emphasized. We conclude that surgical management is primordial. We give anatomopathological rationale for resection of implantation pedicle. The operative mortality was nul in this series of 8 patients; major improvement of cardiac status was constant. No recurrence has occurred during the follow-up period. [less ▲]

Non Small Cell Lung Carcinoma (Nsclc) at Stage 3. A Fourteen Years Retrospective Study of 449 Patients. Indications of Surgery in a Multidisciplinary Management

in Acta Chirurgica Belgica (1989), 89(3, May-Jun), 153-8

Through a fourteen years retrospective study of all the patients treated at the State University of Liege, we have focused on the survival of 449 patients with, at least, a clinical stage 3 NSCLC disease ... [more ▼]

Through a fourteen years retrospective study of all the patients treated at the State University of Liege, we have focused on the survival of 449 patients with, at least, a clinical stage 3 NSCLC disease (NORMS UICC). The whole study was divided in two periods (1972-1978, period 1, and 1979-1985, period 2) because, everything remaining nearly equal as far as the clinical material was concerned, period 2 was characterized by a different therapeutic attitude. Since 1979, the NSCLC stage 3's surgical indications have been widely extended. We have performed surgical resections in patients with NSCLC N2 disease because of positive homolateral mediastinal lymph nodes or with T3 disease. This led the NSCLC stage 3 resection rate to move from 26% in period 1 to 47% in period 2. We report here the effects of such a management on the short and long term survival and the stage 3 NSCLC global prognosis. We noted a modest significant increase in the NSCLC stage 3 global prognosis with a five year survival of 4% and 6% (period 1 and 2 respectively; P = 0.03). The 172 resected patients' outcome did not change (five year survival 11% (P1) and 12% (P2]. Although patients were not randomized, our results suggest that adjuvant therapy should not be added whenever the patient underwent a complete resection. On the other hand, it seems very useful indeed whenever the resection was partial. NSCLC patient at stage 3 who underwent a complete resection achieved a 37% five years survival. [less ▲]