[ARVD-FORUM] ARVD. Dr. Colque's case. Dr. Perez Riera

[ARVD Symposium]

English - Spanish

Thank you for your opinion Dr. Riera. Is similar than Dr. Chachques issued at 
list.

Roberto MA Colque, MD

---------------------

Gracias por su opinión, Dr.. Riera.  Es similar a la del Dr. Chachques 
publicada en la lista.  

Roberto MA Colque, MD



> English - Portuguese
>
> English
>
> Orthotopic Heart transplantation is the surgical procedure of choice for
> treatment of refractory heart failure. However, it benefits a small number
> of patients because of the limited number of donors and selection criteria
> of recipients. Anterior Dynamic Cardiomyoplasty is an alternative surgical
> procedure for heart failure. In properly selected patients, cardiomyoplasty
> and heart transplantation seem to be associated with improvement in
> survival and functional class at mid-term follow-up. Orthotopic Heart
> transplantation was more effective than cardiomyoplasty for functional
> class improvement. (Bocchi EA, Bellotti G, Moreira LF,  et al.  Mid-term
> results of heart transplantation, cardiomyoplasty, and medical treatment of
> refractory heart failure caused by idiopathic dilated cardiomyopathy. J
> Heart Lung Transplant. 1996; 15:736-745.).
>
> The mechanisms of action of dynamic cardiomyoplasty include the enhancement
> of LV systolic function, by the direct action of synchronized skeletal
> muscle flap contraction and the reversion of chamber remodeling. Moreover,
> both mechanisms seem to be responsible for improved diastolic function
> properties and for the decrease of ventricular wall stress. (Moreira LF,
> Bocchi EA, Stolf NA, Dynamic cardiomyoplasty in the treatment of dilated
> cardiomyopathy: current results and perspectives.J Card Surg.
> 1996;11:207-216.).
>
> RV cardiac failure has been controlled by anterior dynamic cardiomyoplasty
> (Fontaine G, Hebert JL, Prost-Squarcioni C, et al. Arrhythmogenic right
> ventricular dysplasia Arch Mal Coeur Vaiss. 2004; 97:1155-1159)
>
> The procedure has no effect on the microscopic structure of the RV
> myocardium. (Benvenuti LA, Moreira LF, Aiello VD, et al. Sequential
> histologic analysis of the myocardium after dynamic cardiomyoplasty: A
> study based on right ventricular endomyocardial biopsies. J Heart Lung
> Transplant. 2004; 23:1438-1440.).
>
> Best regard
>
> Andrés Ricardo Pérez Riera
>
>
>
> Português
>
> O transpante ortóptico e o procedimento de escolha para o tratamento da
> falha cardiaca refratária, porém, este procedimeno beneficia um pequeno
> número de pacientes pelo limitado numero de doadores e os critérios de
> selecao dos receptors. A Cardiomioplastia anterior dinâmica é uma
> alternativa de procedimento cirúrgico para a falha cardiaca refratária. Em
> casos
> sseleccionados cardiomioplastia e o transplante ortóptico ocasionam melhora
> na sobrevida e na classe funcional a medio prazo. O transplante ortóptico
> foi mais efetivo que a cardiomioplastia na melhora da classe funcional
> (Bocchi EA, Bellotti G, Moreira LF,  et al.  Mid-term results of heart
> transplantation, cardiomyoplasty, and medical treatment of refractory heart
> failure caused by idiopathic dilated cardiomyopathy. J Heart Lung
> Transplant. 1996; 15:736-745.).
>
> O mecanismo de açào da cardiopmioplstia dinâmica inclue melhora da função
> sistólica do VD, pela acao direta do músculo esquelético sincronzado
> condicionando uma reversao do remodelamento. Ambos mecanismos parecem ser
> responsáveis pela melhora das propiedades diastólicas e diminuição do
> estresse na parede (Moreira LF, Bocchi EA, Stolf NA, Dynamic
> cardiomyoplasty in the treatment of dilated cardiomyopathy: current results
> and
> perspectives.J Card Surg. 1996;11:207-216.). Fo falho do VD tem sido
> controlado com a cardiomioplastia anterior dinâmica. (Fontaine G, Hebert
> JL, Prost-Squarcioni C, et al. Arrhythmogenic right ventricular dysplasia
> Arch Mal Coeur Vaiss. 2004; 97:1155-1159)
>
> O procedimento na estrutura microscópica do VD (Benvenuti LA, Moreira LF,
> Aiello VD, et al. Sequential histologic analysis of the myocardium after
> dynamic cardiomyoplasty: A study based on right ventricular endomyocardial
> biopsies. J Heart Lung Transplant. 2004; 23:1438-1440.).
>
> Saludações
>
> Andrés Ricardo PérezRiera.
>
> > 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)
> >
> > -----------------------------------------
> >
> > 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)