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The Effect of Cardiomyoplasty on Left Atrial Function in Experimental Canine Models^*

^* From the Department of Surgery, Division II, Kobe University School of Medicine, Kobe, Japan.

Correspondence to: Yoshio Ootaki, MD, Department of Surgery, Division II, Kobe University School of Medicine, Kobe, Japan 7–5-2 Kusunoki-chou, Chuou-ku, Kobe, Hyogo, 650-0017, Japan; e-mail: y.ootaki{at}nifty.ne.jp

Background: Cardiomyoplasty utilizes the latissimus dorsi muscle to boost the failing ventricle. However, the mechanism for clinical improvement still remains controversial. We have previously shown that left ventricular contraction was improved in the long-term periods after cardiomyoplasty in the normal canine heart model and in the dilated failing heart model. On the other hand, right ventricular filling was impaired if a rapid volume loading test was employed in the long-term period after cardiomyoplasty. The purpose of the present study was to determine whether cardiomyoplasty impairs the left atrial function and affects ventricular filling.

Method: Eleven mongrel dogs that had undergone cardiomyoplasty (study group, n = 5) or a sham operation (control group, n = 6) were studied for 12 weeks postoperatively. An IV 4.5% albumin solution (10 mL/kg) was infused into the right atrium, and hemodynamic changes in right cardiac catheterization and left atrial volume (LAV) were obtained by two-dimensional echocardiography. Atrial function was assessed by hemodynamic changes in Doppler echocardiography and hormonal changes.

Results: Stroke volume was significantly increased, from 17.0 ± 4.4 to 21.1 ± 7.0 mL, respectively, before and 15 min after albumin infusion in the control group (p < 0.05). Heart rate and cardiac output were significantly increased, from 131.2 ± 18.1 to 152.0 ± 9.8 beats/min and 2.72 ± 1.29 to 4.03 ± 1.67 L/min, respectively, before and 15 min after albumin infusion in the study group (p < 0.05). No changes were observed in mean right atrial pressure and pulmonary capillary wedge pressure. LAV and atrial natriuretic peptide (ANP) levels increased significantly, from 5.8 ± 2.1 to 8.5 ± 3.8 mL and 22.5 ± 7.5 to 44.5 ± 31.7 pg/mL, respectively, before and 15 min after albumin infusion in the control group (p < 0.05). In the study group, LAV and ANP levels were also increased, from 10.1 ± 2.4 to 12.7 ± 2.8 mL and 64.2 ± 60.6 to 232.6 ± 272.2 pg/mL, respectively, before and 15 min after albumin infusion (p < 0.05). The peak velocities and the time-velocity integrals in the pulmonary venous flow of the systolic and diastolic waves, as well as their ratios (systolic to diastolic peak velocity ratio and systolic to diastolic time-velocity integral ratio) showed no significant differences between the two groups.

Conclusions: Cardiomyoplasty preserves left atrial filling and transport function; therefore, cardiomyoplasty may also activate ANP production by stimulating the atrium in the long-term period after cardiomyoplasty.

Key Words: atrial function • atrial natriuretic peptide • cardiomyoplasty • volume loading