title: Similar left and right ventricular sarcomere structure after support with a left ventricular assist device suggests the utility of right ventricular biopsies to monitor left ventricular reverse remodeling.
abstract: BACKGROUND
  To evaluate whether the morphology of the contractile filaments in cardiomyocytes of patients with end-stage heart failure, treated with a left ventricular assist device (LVAD), is identical in the left- and right ventricle (LV, RV) and in the interventricular septum (IVS) and can be monitored by biopsies taken with a bioptome. The application of an LVAD as a bridge to recovery of cardiac function requires monitoring of myocyte recovery. The use of RV biopsies for this purpose might be feasible, if morphologic findings in the RV coincide with those in the LV.
  
  
  RESULTS
  At the time of heart transplantation, myocardial biopsies of LV, RV and IVS from 13 patients after LVAD support were compared using immunohistochemistry with monoclonal antibodies against contractile proteins. Additionally, in five of these patients, small biopsies obtained with a diagnostic bioptome were compared with large transmural biopsies of the same region. Hemodynamic monitoring was performed when the patients were fully recovered from the implantation, to rule out persistent RV failure. The staining pattern of actin, myosin, tropomyosin, troponin T and C was identical in the biopsies of LV, RV and IVS. Small biopsies taken with a bioptome appeared to be representative for the larger biopsies. Hemodynamic monitoring showed absence of RV failure in our study group.
  
  
  CONCLUSIONS
  In the absence of RV failure, morphology of the contractile myofilaments after LVAD support for 215+/-143 days is identical in LV, RV and IVS. This may allow monitoring of the possible occurrence of LV reverse remodeling by RV biopsies.
authors.affiliation: Heart Lung Center Utrecht, University Medical Center Utrecht, Utrecht, Netherlands. n.dejonge@azu.nl
authors.forename: Nicolaas
authors.initials: N
authors.lastname: de Jonge
authors.forename: Jaap R
authors.initials: JR
authors.lastname: Lahpor
authors.forename: Dick F
authors.initials: DF
authors.lastname: van Wichen
authors.forename: Hans
authors.initials: H
authors.lastname: Kirkels
authors.forename: Frits H J
authors.initials: FH
authors.lastname: Gmelig-Meyling
authors.forename: Jan G
authors.initials: JG
authors.lastname: van den Tweel
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.forename: Roel A
authors.initials: RA
authors.lastname: de Weger
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D003285:Contractile Proteins / Q000378:metabolism; D005260:Female; D006333:Heart Failure / Q000378:metabolism / Q000473:pathology* / Q000628:therapy*; D006352:Heart Ventricles / Q000166:cytology* / Q000378:metabolism / Q000473:pathology; D006353:Heart-Assist Devices; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D032383:Myocytes, Cardiac / Q000473:pathology; D012518:Sarcomeres / Q000473:pathology*; D016277:Ventricular Function, Left
chemical_list: D003285:Contractile Proteins