[ARVD-FORUM] ARVD. Dr. Colque's case. Dr. Chachques

[ARVD Symposium]

English - Spanish

Dear Dr. Colque and colleagues participating in the Symposium:
In the Broussais Hospital and then the Pompidou Hospital from Paris, we have
had the chance to treat surgically 10 patients with right ventricular
failure (7 cases with ARVD). Most of these patients were referred by Dr. Guy
Fontaine. The surgical indication was caused by the fact that these patients
had right cardiac failure refractory to pharmacological treatment and
presenting severe arrhythmias. We performed a right anterior
CARDIOMYOPLASTY, using the wide pedicled transposed left dorsal muscle, to
the interior of the chest cavity. We associated an annuloplasty of the
tricuspid valve (by Carpentier ring). Then, the muscle was
electro-stimulated synchronically during systoles, through specific
electrodes and pacemaker (Cardio-Myostimulator) implanted during the
operation. The results were excellent (follow-up up to 12 years), with
hemodynamic improvement, disappearance of ascitis and edema of inferior
limbs. Arrhythmias were significantly reduced. The effects of this cardiac
bioassistance are attributed to chronic systolic compression and ventricular
dilatation restriction (positive remodeling), which would reduce tension and
excitability of myocardial fibers. This technique and results were published
by our group in the Annals of Thoracic Surgery 2003; 75:1464-8. Dr. Colque's
patient could benefit from this intervention, which doesn't need organ
donors or immunosuppression. In the case of an unfavorable evolution in the
long term, cardiomyoplasty does not prevent performing a cardiac
transplantation afterwards.

Juan Carlos Chachques (email: j.chachques at brs.ap-hop-paris.fr)

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Estimado Dr. Colque y colegas participantes en el Simposio:
En los hospitales Broussais y luego Pompidou de Paris, hemos tenido la
oportunidad de tratar quirurgicamente 10 pacientes con insuficiencia
ventricular derecha (7 casos con DAVD). La mayoria de esos pacientes fueron
enviados por el Dr. Guy Fontaine. La indicacion quirurgica fue motivada por
tratarse de pacientes con insuficiencia cardiaca derecha refractarios al
tratamiento farmacologico y presentando arritmias graves. Realizamos una
CARDIOMIOPLASTIA anterior derecha, utilizando el musculo dorsal ancho
izquierdo pediculizado y traspuesto al interior de la cavidad toracica. Se
asocio una anuloplastia de la valvula tricuspide (mediante anillo de
Carpentier). El musculo fue luego electroestimulado sincronicamente durante
las sistoles mediante electrodos especificos y pacemaker
(Cardio-Myostimulator) implantados durante la intervencion. Los resultados
fueron excelentes (follow-up hasta 12 años), con mejoria hemodinamica,
desaparicion de ascitis y del edema de miembros inferiores. Las aritmias
disminuyeron significativamente. Los efectos de esta bioasistencia cardiaca
son atribuidos a la comprension sistolica cronica y a la
limitacion de la dilatacion ventricular (remodelaje positivo), que reduciria
la tension y la exitabilidad de las fibras miocardicas. Esta técnica y
resultados fueron publicados por nuestro grupo en la revista Annals of
Thoracic Surgery 2003; 75:1464-8. El paciente del Dr. Colque podria
beneficiar de esa intervencion que no necesita donantes de organos ni
inmunosupresion. En el caso de una evolucion a largo plazo desfavorable, la
cardiomioplkastia no impide la realizacion ulterior de un trasplante
cardiaco.

Juan Carlos Chachques (email: j.chachques at brs.ap-hop-paris.fr)