CARDIOMYOPLASTY TO IMPROVE MYOCARDIAL COLLATERAL BLOOD-SUPPLY AS AN ALTERNATIVE TO TRANSPLANTATION IN INTRACTABLE ANGINA

In diffuse small-vessel coronary heart disease, heart transplantation may be indicated for intractable angina. As an alternative, a free striated muscle flap can constitute a source of neovessels. Those extraintracardial collaterals develop only 4 weeks after transplantation of the flap as shown by the following experiments with seven dogs. In those animals a myocardial infarction of the anterior wall was selectively produced by the Judkins technique for the injection of Sephadex microspheres. Four weeks later a free pectoralis muscle flap was transplanted onto the anterior wall of the heart. Arterial blood supply was achieved by anastomosis with the internal mammary artery. The venous flow was directed into the right atrium. Six weeks after surgery the patency of the anastomosis was studied by angiography, which showed patency in all animals. Pathologic examination of the hearts revealed a prominent capillary network penetrating into the underlying myocardium. Corrosion cast preparations showed even further penetration of the capillary network into the noninjured parts of the myocardium. Thus myocardial revascularization could be achieved by transplantation of a skeletal muscle on the heart.