The performance of the heart in the intact subject is determined by the complex interplay of cardiac and extracardiac factors; the initial length of the myocardial fibers and the state of activity of the cardiac autonomic nerves are most important. The profound changes in cardiac behavior that attend excitation of the cardiac autonomic nerves have led to the concept of neurogenic dominance in the control of cardiac output, particularly in situations that strongly constrain the cardiovascular system. This concept is basic to an evaluation of the mechanisms by which the heart responds to changes in the peripheral circulation and has important implications in clinical cardiac transplantation. In this review, the behavior of the denervated heart in different stressful situations is considered; the presentation is limited to studies in which dogs have been chronically deprived of both sympathetic and parasympathetic nerves. The role of cardiac receptors and their afferent innervation has recently been reviewed and is not discussed in this paper (1, 2).
TECHNIQUES OF CARDIAC DENERVATIONThe four major techniques of cardiac denervation currently used are described briefly, because the method of denervation will influence the results obtained.(1) According to the methods of Gasser and Meek (3) and of Ashkar and Hamilton (4), the stelllate ganglia and thoracic paravertebral sympathetic chains are bilaterally excised from T-l to T-4. The right vagus nerve is sectioned distal to the right recurrent laryngeal nerve. During a second operation, the left vagus nerve is sectioned in the neck. Some cardiac sympathetic fibers remain biable but decentralized, and the myocardial content of catecholamines is reduced to a varying degree. Supersensitivity to catecholamines does not devel-From the Department of Physiology and Biophysics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55901.
Circulation Research. VoL XXXIV, April 1974op. The lungs and viscera are vagally denervated, resulting in altered respiratory dynamics, gastrointestinal disturbances, and loss in body weight. Vagal cardiopulmonary afferent nerves are interrupted.(2) Complete cardiac denervation is assured after orthotopic autografts or allografts. This techniquerequires cardiac bypass and results in significant morbidity and mortality. Sympathetic denervation is postganglionic, and the heart is depleted of and becomes supersensitive to catecholamines. Pulmonary afferent fibers are preserved, but afferent fibers that course along the aorta, the main pulmonary artery, or the superior vena cava are interrupted. Dependong on the technique used, afferent fibers from receptors in the pulmonary veins, posterior atrial wall, and ostia of the vena cava may (5) or may not (6) be preserved. After transplantation, variability in the functional integrity of the donor sinus node has been noted.(3) The technique of regional neural ablation (7) involves stripping the aorta, the main, right, and left pulmonary arteries, the pulmonary veins, the atria, and the vena cava. The per...