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European Heart Journal 1998 19(2):310-318; doi:10.1053/euhj.1997.0590
Copyright © 1998 by the European Society of Cardiology.
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Structural alterations in the latissimus dorsi muscles in three patients more than 2 years after a cardiomyoplasty procedure

J.H.L. Davidsea, F.H. van der Veena, C.M.H.B. Lucasa, O.C.K.M. Pennb, M.J.A.P. Daemenc and H.J.J. Wellensa

a Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital Maastricht, Maastricht, The Netherlands
b Department of Cardiac Surgery, Cardiovascular Research Institute Maastricht (CARIM), University Hospital Maastricht, Maastricht, The Netherlands
c Departments of Pathology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital Maastricht, Maastricht, The Netherlands

accepted May 30, 1997

Aims

The long-term effects of the use of the latissimus dorsi muscle for dynamic cardiomyoplasty were studied. Skeletal muscle fast fatiguable type II fibres are transformed to highly fatigue-resistant type I fibres in animal models, and is assumed to occur in men. However, it is not known whether this same transformation occurs in patients with chronic heart failure.

Methods and results

Three patients who underwent a cardiomyoplasty procedure (pre-operative NYHA class IV) were studied. The left latissimus dorsi muscle was stimulated, according to routine clinical protocol, with 30Hz bursts in a 2:1 ratio to cardiac activation. The patients died more than 2 years after surgery and five autopsy samples were obtained at defined places in the wrapped muscle.In the proximal part of the latissimus dorsi muscle, the type I fibres comprised 68–80% in all three patients, whereas peroperatively type I fibres comprised 17–30% indicating significant but not complete transformation. Transformation in the latissimus dorsi muscle as a whole appeared to be inhomogeneous, with type I fibres ranging from 10–80%. An extensive amount of muscle fibre appeared to be replaced by fatty tissue (10%–50%). This occurred at random and resulted in complete loss of muscle structure. A significant increase in the density of small arteries was observed in the latissimus dorsi after transformation.

Conclusions

In these patients, muscle fibre type transformation was not as complete as that observed in animal experiments, and was accompanied by loss of muscle viability. The stimulation current in the latissimus dorsi muscle appeared not to be the direct cause of local tissue lipomatosis or collagen deposition.

Key Words: Cardiomyopathy • biopsy • electrical stimu-lation • men • surgery

Correspondence: Dr Frederik H. van der Veen, PhD, University Hospital Maastricht, Department of Cardiology, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.


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