Ismail S, Johnson S H, Utsunomiya H, Craig D, Kisslo J A, Smith P K
Department of Surgery, Duke University Medical Center, Durham, NC 27710.
Clin Cardiol. 1991 Nov;14(11 Suppl 5):V29-32. doi: 10.1002/clc.4960141707.
This study was designed to identify a concentration of sonicated albumin microspheres that is safe, useful in determining graft patency, and provides an estimate of regional myocardial perfusion. The study included 8 patients between 50 and 72 years of age who were undergoing coronary artery bypass grafting. All patients were hemodynamically stable with left ventricular ejection fractions greater than or equal to 0.35. None had congestive heart failure or myocardial infarction within 4 months prior to the study. All had normal baseline neurologic and renal functions, and none had experienced allergic reactions to blood products or contrast dyes. A standard median sternotomy was performed for exposure of the heart at surgery, and saphenous veins were harvested and used for grafting. Intraoperative epicardial echocardiography (EE), always in the left ventricle short-axis at midpapillary level, was performed before and after grafting to determine regional myocardial wall motion. Sonicated albumin microspheres were prepared and injected into a single vein graft using an 18-gauge needle; 20 x 10(6), 100 x 10(6), and 200 x 10(6) microspheres were injected into the first graft sequentially. All other vein grafts were injected once with the dose that gave optimal contrast enhancement in the initial graft studied. In each patient, a minimum of 3 and maximum of 5 injections were performed, and graft perfusion was studied using EE. Graft flow, blood pressure, and electrocardiographic (ECG) measurements were continuously monitored, with a final EE performed after weaning the patient off cardiopulmonary bypass to assess wall motion. Preliminary results showed that no patient had adverse effects during or after the study and all remained hemodynamically stable.(ABSTRACT TRUNCATED AT 250 WORDS)
本研究旨在确定一种经超声处理的白蛋白微球浓度，该浓度安全、有助于确定移植物通畅情况，并能提供局部心肌灌注的估计值。研究纳入了8例年龄在50至72岁之间、正在接受冠状动脉旁路移植术的患者。所有患者血流动力学稳定，左心室射血分数大于或等于0.35。在研究前4个月内，无一例患者发生充血性心力衰竭或心肌梗死。所有患者基线神经和肾功能均正常，且均未对血液制品或造影剂发生过敏反应。手术时采用标准正中胸骨切开术暴露心脏，采集大隐静脉用于移植。术中在乳头肌水平的左心室短轴进行心外膜超声心动图（EE）检查，分别在移植前后进行，以确定局部心肌壁运动情况。制备经超声处理的白蛋白微球，并用18号针头注入单条静脉移植物；将20×10⁶、100×10⁶和200×10⁶个微球依次注入第一条移植物。所有其他静脉移植物均注入在最初研究的移植物中产生最佳对比增强效果的剂量。每位患者至少进行3次、最多进行5次注射，并使用EE研究移植物灌注情况。持续监测移植物血流、血压和心电图（ECG）测量值，在患者脱离体外循环后进行最后一次EE检查以评估壁运动情况。初步结果显示，研究期间及研究后无患者出现不良反应，所有患者血流动力学均保持稳定。（摘要截短至250字）
