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  • Model  (2)
  • Springer  (2)
  • Blackwell Science Ltd
  • 1
    ISSN: 1573-9686
    Keywords: Elastance ; Stroke volume ; Model ; Cardiomyoplasty
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Technology
    Notes: Abstract Dynamic cardiomyoplasty (DCM) is an emerging surgical procedure for heart failure in which the patient's latissimus dorsi (LD) muscle is wrapped around the heart and stimulated to contract in synchrony with the heartbeat as a cardiac assist measure. A 6 week training protocol of progressive electrical stimulation renders the normally fatigueable skeletal muscle fatigue-resistant and suitable for chronic stimulation. To date, over 500 procedures have been performed in worldwide clinical trials. Investigators typically report symptomatic improvement and modest hemodynamic improvement in patients. Controversy exists regarding the exact mechanism of DCM. To test the hypothesis that DCM augments cardiac stroke volume through improvement in systolic function, we formulated an engineering model of dynamic cardiomyoplasty to predict stroke volume. The heart and the LD were modeled as nested (series) elastance chambers, and the vasculature was represented by a two-element Windkessel model. Using five healthy goats, we verified model predictions of stroke volume for both stimulator ON beats (y=1.00x−0.08, r=0.87, p 〈 0.0001) and OFF beats (y=1.01x+1.06, r=0.91, p 〈 0.0001), where x and y are the measured and predicted stroke volumes, respectively. The model confirms that using untrained latissimus dorsi applied to the normal myocardium produces only moderate increases in stroke volume and suggests that future research should focus on increasing LD strength after training.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1573-9686
    Keywords: Clinical cardiomyoplasty ; Nomogram ; Muscle transformation ; Model ; Cardiomyoplasty ; Applications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Technology
    Notes: Abstract Previously, a modification to the Sunagawa engineering model for the isolated left ventricle and arterial system was proposed and validated for dynamic cardiomyoplasty in an acute goat preparation. To test the hypothesis that this model may be applied to the clinical scenario in cardiomyoplasty patients, we predicted human stroke volume using the model with human clinical data from the literature. Predicted stroke volume correlated well with published stroke volume in patients who have had the dynamic cardiomyoplasty procedure. These results suggest that the modest hemodynamic improvement commonly reported after the procedure is performed may be due to diminished latissimus dorsi strength after transformation. The validity of both the original Sunagawa model and the previously proposed modification for dynamic cardiomyoplasty is further supported with these results. A nomogram methodology for predicting stroke volume after dynamic cardiomyoplasty for any particular patient is presented.
    Type of Medium: Electronic Resource
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