Abstract
Both myocardial infarction and volume overloading associated with regurgitant valve lesions lead to eccentric left ventricular (LV) hypertrophy. The mechanism is presumed to be positive feedback between diastolic LV wall stress and eccentric LV hypertrophy. Further, in each case, an increase in LV size is an important adverse prognostic finding. The experience with skeletal muscle cardiomyoplasty led to the hypothesis that passive constraint of LV enlargement would interrupt the diastolic stress and eccentric hypertrophy cycle, in addition to halting and possibly reversing the adverse LV remodeling. A number of passive constraint devices such as the Acorn CorCap™ Cardiac Support Device (CSD), Paracor Medical HeartNet™ Ventricular Support System (VSS), and Myocor™ yosplint® have been used. Most recently, an Adjustable Fluid Filled Balloon CSD was proposed by Ghanta and colleagues. In this chapter we model the effect of passive constraint devices, with the exception of the Paracor Medical HeartNet™ VSS, on the LV stroke volume/end-diastolic pressure (Starling) relationship and regional distributions of stress in the local muscle fiber direction.
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References
Hammermeister KE, DeRouen TA, Dodge HT. Variables predictive of survival in patients with coronary disease. Selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, and quantitative angiographic evaluations. Circulation. 1979;59:421–30.
Kostuk WJ, Kazamias TM, Gander MP, Simon AL, Ross J Jr. Left ventricular size after acute myocardial infarction. Serial changes and their prognostic significance. Circulation. 1973;47:1174–9.
Shanoff HM, Little JA, Csima A, Yano R. Heart size and ten-year survival after uncomplicated myocardial infarction. Am Heart J. 1969;78:608–14.
White HD, Norris RM, Brown MA, Brandt PW, Whitlock RM, Wild CJ. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation. 1987;76:44–51.
Douglas PS, Morrow R, Ioli A, Reichek N. Left ventricular shape, afterload and survival in idiopathic dilated cardiomyopathy. J Am Coll Cardiol. 1989;13:311–5.
Grossman W, Jones D, McLaurin LP. Wall stress and patterns of hypertrophy in the human left ventricle. J Clin Invest. 1975;56:56–64.
Hagege AA, Desnos M, Fernandez F, Besse B, Mirochnik N, Castaldo M, Chachques JC, Carpentier A, Guerot C. Clinical study of the effects of latissimus dorsi muscle flap stimulation after cardiomyoplasty. Circulation. 1995;92:II210–5.
Kass DA, Baughman KL, Pak PH, Cho PW, Levin HR, Gardner TJ, Halperin HR, Tsitlik JE, Acker MA. Reverse remodeling from cardiomyoplasty in human heart failure. External constraint versus active assist. Circulation. 1995;91:2314–8.
Nakajima H, Niinami H, Hooper TL, Hammond RL, Nakajima HO, Lu H, Ruggiero R, Thomas GA, Mocek FW, Fietsam R Jr, et al. Cardiomyoplasty: probable mechanism of effectiveness using the pressure–volume relationship. Ann Thorac Surg. 1994;57:407–15.
10. Blom AS, Mukherjee R, Pilla JJ, Lowry AS, Yarbrough WM, Mingoia JT, Hendrick JW, Stroud RE, McLean JE, Affuso J, Gorman RC, Gorman JH 3rd, Acker MA, Spinale FG. Cardiac support device modifies left ventricular geometry and myocardial structure after myocardial infarction. Circulation. 2005;112(9):1274–1283.
Cheng A, Nguyen TC, Malinowski M, Langer F, Liang D, Daughters GT, Ingels NB Jr, Miller DC. Passive ventricular constraint prevents transmural shear strain progression in left ventricle remodeling. Circulation. 2006;114:I79–86.
Pilla JJ, Blom AS, Brockman DJ, Bowen F, Yuan Q, Giammarco J, Ferrari VA, Gorman JH 3rd, Gorman RC, Acker MA. Ventricular constraint using the acorn cardiac support device reduces myocardial akinetic area in an ovine model of acute infarction. Circulation. 2002;106:I207–11.
Chaudhry PA, Mishima T, Sharov VG, Hawkins J, Alferness C, Paone G, Sabbah HN. Passive epicardial containment prevents ventricular remodeling in heart failure. Ann Thorac Surg. 2000;70:1275–80.
Starling RC, Jessup M, Oh JK, Sabbah HN, Acker MA, Mann DL, Kubo SH. Sustained benefits of the CorCap Cardiac Support Device on left ventricular remodeling: three year follow-up results from the Acorn clinical trial. Ann Thorac Surg. 2007;84(4):1236–1242.
Mann DL, Acker MA, Jessup M, Sabbah HN, Starling RC, Kubo SH. Clinical evaluation of the CorCap Cardiac Support Device in patients with dilated cardiomyopathy. Ann Thorac Surg. 2007;84(4):1226–1235.
Pelton A. Nitinol medical devices. Adv Mater Processes. 2005;163:S13(3).
Magovern JA. Experimental and clinical studies with the Paracor cardiac restraint device. Semin Thorac Cardiovasc Surg. 2005:17, 364–8.
Magovern JA, Teekell-Taylor L, Mankad S, Dasika U, McGregor W, Biederman RW, Yamrozik J, Trumble DR. Effect of a flexible ventricular restraint device on cardiac remodeling after acute myocardial infarction. Asaio J. 2006;52(2):196–200.
Cheng Y, Yi G, Hay I, Qin S, He K, Yue K, Li X, Tao Y, Wang J. A novel left ventricular passive support device alters the natural history of chronic heart failure in awake dogs. New Orleans, LA: AHA Scientific Sessions, 2004.
McCarthy PM, Takagaki M, Ochiai Y, Young JB, Tabata T, Shiota T, Qin JX, Thomas JD, Mortier TJ, Schroeder RF, Schweich CJ Jr, Fukamachi K. Device-based change in left ventricular shape: a new concept for the treatment of dilated cardiomyopathy. J Thorac Cardiovasc Surg. 2001;122:482–90.
Ghanta RK, Rangaraj A, Umakanthan R, Lee L, Laurence RG, Fox JA, Bolman RM 3rd, Cohn LH, Chen FY. Adjustable, physiological ventricular restraint improves left ventricular mechanics and reduces dilatation in an ovine model of chronic heart failure. Circulation. 2007;115:1201–10.
Humphrey JD. Cardiovascular solid mechanics: cells, tissues, and organs. New York: Springer, 2002, p. 757, pp. xvi.
Guccione JM, Costa KD, McCulloch AD. Finite element stress analysis of left ventricular mechanics in the beating dog heart. J Biomech. 1995;28:1167–77.
Guccione, JM, Salahieh A, Moonly SM, Kortsmit J, Wallace AW, Ratcliffe MB. Myosplint decreases wall stress without depressing function in the failing heart: a finite element model study. Ann Thorac Surg. 2003;76:1171–80.
Walker JC, Ratcliffe MB, Zhang P, Wallace AW, Fata B, Hsu EW, Saloner D, Guccione JM. MRI-based finite-element analysis of left ventricular aneurysm. American journal of physiology. 2005;289(2):H692–700.
Oz MC, Konertz WF, Kleber FX, Mohr FW, Gummert JF, Ostermeyer J, Lass M, Raman J, Acker MA, Smedira N. Global surgical experience with the Acorn cardiac support device. J Thorac Cardiovasc Surg. 2003;126:983–91.
Walsh RG. Design and features of the Acorn CorCap Cardiac Support Device: the concept of passive mechanical diastolic support. Heart Fail Rev. 2005;10:101–7.
Acknowledgments
This research was supported by National Institutes of Health grant 5R01 HL077921 (Dr. Guccione) and 5R01 HL063348 (Dr. Ratcliffe). We thank Ms. Kimberly S. Yan, a technical writing expert for proof-reading of this chapter.
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Jhun, CS. et al. (2010). Passive Left Ventricular Constraint Devices. In: Guccione, J., Kassab, G., Ratcliffe, M. (eds) Computational Cardiovascular Mechanics. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-0730-1_13
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DOI: https://doi.org/10.1007/978-1-4419-0730-1_13
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