Nienaber C A, Rehders T C, Abend M, Chen C
Abteilung für Kardiologie der Medizinischen Klinik und Poliklinik, Universitätskrankenhaus Eppendorf, Hamburg.
Z Kardiol. 1992 Dec;81(12):645-55.
The potentially ischemia-protective effect of ECG-synchronized coronary venous retroperfusion (SRP) with arterial blood via the coronary sinus (CS) was assessed in 26 patients (56 +/- 10 years, 22 male, 4 female) in the clinical scenario of PTCA of a proximal LAD stenosis. In six additional patients the SRP procedure failed due to anatomical or technical reasons. In an intraindividual comparison at least two standardized balloon inflations for 60 seconds at 6-8 atm were performed in randomized order with and without continuous SRP at a flow rate of 200 +/- 46 ml/min. Under both conditions echocardiographic regional wall motion, ST depression in leads V1-6, hemodynamic parameters and symptoms expressed in a pain score were continuously monitored during angioplasty. This study revealed that the echocardiographic regional wall motion score in the perfusion territory of the dilated artery increased from 1.65 +/- 1.81 at baseline to 5.65 +/- 2.88 (p < 0.001) during a one minute dilatation without SRP. With SRP-support the regional wall motion at 1 minute angioplasty was significantly improved to 3.55 +/- 2.80 (p < 0.025). Moreover, the ischemic ECG-changes were markedly less pronounced, whereas the subjective perception of anginal pain was not different as a function of SRP-support. Thus, the simultaneous coronary venous retroperfusion with arterial blood has ischemia-protective potential in elective PTCA of a proximal LAD stenosis and may reduce ischemic dysfunction with prolonged balloon inflations.
在26例（年龄56±10岁，男22例，女4例）患有左前降支近端狭窄并接受经皮冠状动脉腔内血管成形术（PTCA）的患者中，评估了经冠状静脉窦（CS）进行心电图同步冠状动脉静脉逆行灌注（SRP）并使用动脉血的潜在缺血保护作用。另外6例患者因解剖学或技术原因，SRP操作失败。在个体内比较中，以随机顺序在有和没有以200±46 ml/min的流速进行连续SRP的情况下，至少进行两次标准化球囊充气，在6-8个大气压下持续60秒。在两种情况下，在血管成形术期间持续监测超声心动图区域壁运动、V1-6导联的ST段压低、血流动力学参数以及以疼痛评分表示的症状。本研究表明，在无SRP的情况下，扩张动脉灌注区域的超声心动图区域壁运动评分在基线时为1.65±1.81，在一分钟扩张期间增加至5.65±2.88（p<0.001）。在SRP支持下，血管成形术1分钟时的区域壁运动显著改善至3.55±2.80（p<0.025）。此外，缺血性心电图变化明显减轻，而心绞痛的主观感受在有无SRP支持的情况下并无差异。因此，在左前降支近端狭窄的选择性PTCA中，同时进行冠状动脉静脉逆行灌注动脉血具有缺血保护潜力，并且可能减少长时间球囊充气引起的缺血性功能障碍。
