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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. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cardiac tamponade is associated with fatal outcomes for patients with acute type A aortic dissection, and the presence of cardiac tamponade should prompt urgent aortic repair. However, treatment of the patient with critical cardiac tamponade who cannot survive until surgery remains unclear. We analyzed our experience of controlled pericardial drainage (CPD) managing critical cardiac tamponade. METHODS AND RESULTS: Between September 2003 and May 2011, 175 patients with acute type A aortic dissection were treated surgically, including 43 (24.6%) who presented with cardiac tamponade on arrival. Eighteen patients, who did not respond to intravenous volume resuscitation, underwent CPD in the emergency department. An 8F pigtail drainage catheter was inserted percutaneously, and drainage volume was controlled by means of several cycles of intermittent drainage to maintain blood pressure at ~=90 mm Hg. After CPD, all of the patients were transferred to the operating room, and immediate aortic repair was performed. Systolic blood pressure before CPD was 64.3±8.2 mm Hg and elevated significantly in all of the cases after CPD. Systolic blood pressure after CPD was 94.8±10.5 mm Hg, and increase in systolic pressure was 30.5±11.7 mm Hg. Total volume of aspirated pericardial effusion was 40.1±30.6 mL, and 10 patients required only <=30-mL aspiration volume. All of the patients underwent aortic repair successfully. In-hospital mortality was 16.7%; however, there was no complications or mortality related to CPD. CONCLUSIONS: Preoperative pericardial drainage with control of volume is a safe and effective procedure for acute type A aortic dissection complicated by critical cardiac tamponade. In our patient population, timely controlled pericardial drainage is warranted. [ABSTRACT FROM AUTHOR]