主动脉冠状动脉搭桥手术后心房起搏缺血反应的消除。

Abolition of ischemic response to atrial pacing following aortocoronary bypass surgery.

作者信息

Jugdutt B I, Lee S J, Taylor R F

出版信息

Circulation. 1976 Aug;54(2):225-9. doi: 10.1161/01.cir.54.2.225.

DOI:10.1161/01.cir.54.2.225

Abstract

To determine the effect of successful aortocoronary bypass surgery (ACBS) on left ventricular (LV) function, the ischemic response to right atrial pacing (RAP) was studied in 22 angina patients before and 3.8 +/- 1.1 months after surgery. All patients were free of angina after ACBS and had at least one patent graft. Before ACBS, RAP induced angina in 15 patients (Group 1) but not in 7 patients (Group 2). After ACBS, no patient had angina with RAP despite the increased maximum rate of pacing. Post-pacing LV end-diastolic pressure (LVEDP) after ACBS decreased in Group 1 from 25 +/- 6 to 15 +/- 6 mm Hg (P less than 0.01), but not in Group 2. Changes in ejection fraction, cardiac output, resting LVEDP, or LVEDP after LV angiography were not significant in either group and were therefore not useful in evaluating the result of ACBS. However the ischemic response to right atrial pacing was abolished by successful aortocoronary bypass surgery, suggesting improved myocardial perfusion during stress.

摘要

为了确定成功的主动脉冠状动脉搭桥手术（ACBS）对左心室（LV）功能的影响，我们对22例心绞痛患者在手术前以及手术后3.8±1.1个月时对右心房起搏（RAP）的缺血反应进行了研究。所有患者在ACBS后均无心绞痛症状，且至少有一支移植血管通畅。在ACBS前，RAP诱发15例患者（第1组）心绞痛发作，但未诱发7例患者（第2组）心绞痛发作。ACBS后，尽管起搏最大心率增加，但无患者因RAP发生心绞痛。ACBS后，第1组起搏后左心室舒张末期压力（LVEDP）从25±6降至15±6 mmHg（P<0.01），而第2组未下降。两组的射血分数、心输出量、静息LVEDP或左心室血管造影后的LVEDP变化均无显著性差异，因此对评估ACBS的结果无帮助。然而，成功的主动脉冠状动脉搭桥手术消除了对右心房起搏的缺血反应，提示应激期间心肌灌注改善。