Szabó G, Buhmann V, Graf A, Melnitchuk S, Hagl S, Vahl C F
Department of Cardiac Surgery, University of Heidelberg, Germany.
Biomed Tech (Berl). 2002;47 Suppl 1 Pt 2:912-4. doi: 10.1515/bmte.2002.47.s1b.912.
We investigated the relationship between coronary perfusion pressure (CPP) and myocardial contractility and the effects of an acute elevation of right atrial pressure (RAP) on this relationship in an experimental model of Fontan circulation in 6 anesthetized open-chest dogs with isolated perfused coronary arteries. The relationship between CPP and Ees could be described by biphasic J-shaped curves which were nearly identical before and under Fontan circulation. While above a "critical" CPP (72 +/- 9 mmHg vs. 81 +/- 8 mmHg, n.s.) the changes of CPP did not affect Ees, below this level the decrease of CPP resulted in a progressive decrease of Ees. Under Fontan circulation, the progressive increase of RAP did not influence Ees at CPP = 100 mmHg, led to a moderate decrease of Ees at CPP = 75 mmHg and severe decrease at CPP = 60 mmHg. Thus, both coronary arterial and venous pressure affect myocardial contractility after Fontan procedure.
我们在6只麻醉开胸、冠状动脉单独灌注的犬类Fontan循环实验模型中，研究了冠状动脉灌注压（CPP）与心肌收缩性之间的关系，以及右心房压力（RAP）急性升高对这种关系的影响。CPP与Ees之间的关系可用双相J形曲线描述，在Fontan循环前和循环期间几乎相同。当高于“临界”CPP（72±9 mmHg对81±8 mmHg，无显著性差异）时，CPP的变化不影响Ees，但低于该水平时，CPP降低会导致Ees逐渐下降。在Fontan循环下，RAP的逐渐升高在CPP = 100 mmHg时不影响Ees，在CPP = 75 mmHg时导致Ees中度下降，在CPP = 60 mmHg时导致严重下降。因此，Fontan手术后冠状动脉压力和静脉压力均影响心肌收缩性。
