title: Physiologic and pathologic evaluation of chronic extra-aortic counterpulsation with latissimus dorsi flap. Preliminary results.
abstract: This study attempted to evaluate the efficacy of chronic extra-aortic counterpulsation with a latissimus dorsi neuro vascular flap. Five dogs had a preliminary procedure consisting of the creation of a latissimus dorsi flap and a thoracotomy in which the flap was wrapped around the descending aorta just distal to the left subclavian artery. An epicardial lead was placed on the left ventricle and a nerve stimulating lead placed around the thoraco-dorsal nerve. Three weeks later, both leads were connected to a cardiomyostimulator programmed to function in a counterpulsation mode with a 1:2 assist frequency. Hemodynamic measurements were made at 6 and 8 and 10 and 12 weeks and the dogs were sacrificed. Three dogs had all sets of hemodynamic measurements made. Two of the three dogs demonstrated diastolic augmentation at 6 and 8 and 10 and 12 weeks average 20 to 25 mmHg. The third dog failed to demonstrate any change. All dogs were sacrificed at 12 weeks and specimens were submitted for histologic evaluation. The muscle flap was preserved in all animals. The aorta subjacent to the flap showed, (1) normal intima with no evidence of disruption or thrombus in all animals, (2) in the animals in whom counterpulsation was observed, there appeared to be thinning of the media in the aorta subjacent to the muscle flap, and (3) no evidence of distal emboli. This study demonstrated that chronic counterpulsation can be obtained with a latissimus dorsi flap. The actual hemodynamic benefits are not determined from this study. The medial thinning in the aortic wall may limit the long-term benefit of this procedure.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery and Department of Pathology, Winthrop-University Hospital, Mineola, New York.
authors.forename: G L
authors.initials: GL
authors.lastname: Hines
authors.forename: Y
authors.initials: Y
authors.lastname: Mishriki
authors.forename: L
authors.initials: L
authors.lastname: Williams
authors.forename: K
authors.initials: K
authors.lastname: Monroe
authors.forename: N
authors.initials: N
authors.lastname: Metwally
mesh_terms: D000818:Animals; D001011:Aorta / Q000503:physiopathology; D015908:Counterpulsation / Q000379:methods*; D004285:Dogs; D006439:Hemodynamics / Q000502:physiology; D009119:Muscle Contraction / Q000502:physiology; D009132:Muscles / Q000098:blood supply* / Q000503:physiopathology; D010138:Pacemaker, Artificial; D011184:Postoperative Period; D013524:Surgical Flaps / Q000379:methods*; D013997:Time Factors