非体外循环心脏减容术治疗扩张型心肌病心力衰竭

目的 对6只充血性心力衰竭犬模型行心脏减容手术减小左心室容积，观察缓解心力衰竭的疗效。方法 6只犬均行右心室快速起搏建立充血性心力衰竭模型，4周后检查及血液动力学指标测定确认模型合格。在非体外循环下施行左心室折叠术以减小左室容积，术中行血液动力学监测，以及经食管内超声心动指导并确认减容程度。结果 除1例术中死亡无法完成监测全部指标外，其余指标均提示心功明显改善。中心静脉压、平均肺动脉压、肺楔压、左室舒张末压、左室收缩压明显降低。左室收缩末期内径、左室舒张末期内径均减少。心输出量、射血分数显著提高。结论 非体外循环心脏减容术是一种新的、有效的治疗终末期扩张型心肌病的外科手术方法。近期效果满意，但远期效果尚有待于进一步观察。

Off-pump left ventricular volume reduction in the treatment of dilated cardiomyopathy causing congestive heart failure

Objective To observe the therapeutic efficacy of left ventricular volume reduciton(LVVR) without the assistance of extracorporeal circulation(Off pump LVVR) on the canine pacing induce heart failure model.Methods Congestive heart failure was induced in 6 dogs by means of rapid ventricul pacing (230 beats/min) for 4 weeks.All dogs underwent plication of the left ventricule without extracorporeal circulation.Hemodynamic and echocardiographic studies were recorded at baseline and immediately after LVVR (acute change).Results The LVVR group had significant sustained improvements in cardiac function from baseline,to the acute change.Central venous pressure,mean pulmonary artery pressure,pulmonary wedge pressure,left ventricular end diaystolic pressure,left ventricular endsystolic diameter,and end diastolic diameter decreased significantly after LVVR,where left ventricular diastolic pressure,cardiac output,and ejection fraction increase markedly.Conclusion Off pump LVVR is a new,effective surgical procedure.As a treatment for end stage dilated cardiomyopathy,the immediate cardiac effects is confirmed,but the long term benfit of the procedure is uncertain.