Cardiomyoplasty is a new approach to the treatment of cardiac insufficiency and its objetive is a control of congestive failure state by the increase of ventricular pumping performance due to improved contractility of the failing heart. At the Heart Institute, from May to December of 1988, latissimus dorsi cardiomyoplasty was performed in 5 patients with dilated cardiomyopathy. The patients were in NYHA. class III or IV despite maximal medical therapy. Etiology was idiopathic in four and due to Chagas' disease in one patient. The mean cardiothoracic ratio was 58 ± 2% and the resting left ventricular ejection fraction (Thecnetium) ranged from 19 to 29%. The operation was performed without extracorporeal circulation and the left latissimus dorsi muscle was wrapped around the right and left ventricles. There were no operative deaths. On the other hand, the loss of muscle flap contraction occurred in one patient due to latissimus dorsi ischemia and this patient died two months later in congestive heart failure. In follow-up ranging from 4 to 9 months, 4 patients that completed the muscle conditioning protocol were in NYHA class I or II with lesser amounts of drugs. Maximal oxygen consumption in treadmill test increased from 13.4 ± 0.8 to 20.6 ± 2.3 ml/min/kg and resting ejection fraction from 23.7 ± 4.2 to 34 ± 7.3%. Hemodynamic evaluation showed that pulmonary wedge pressure decreased from 23.5 ± to 13.2 ± 5.4 mmHg and that stroke work index increased from 15.8 ± 4.2 to 26 ± 7.4 g.M/M². Finally, pulmonary functional test showed that vital capacity decreased 15 ± 4% and a reduction of left lung ventilation was observed after cardiomyoplasty. From these findings, we conclude that cardiomyoplasty may improve ventricular function in patients with dilated cardiomyopathy, leading to reversion of congestive failure. Surgical morbidity appears to be restricted to muscle flap damage and pulmonary function changes due to muscle flap presence in the left hemithorax.
cardiomyoplasty; cardiomyopathies