Mudra H, Zwehl W, Klauss V, Kreuzer E, Theisen K
Medizinische Klinik, Universität München.
Z Kardiol. 1991 Jun;80(6):373-81.
In order to minimize the rate of inadequate myocardial revascularizations, an intraoperative evaluation of regional myocardial perfusion could have practical impact. Current bypass flow measurements have inherent limitations and can determine only epicardial blood flow. To analyze regional graft-dependent myocardial blood flow an echocardiographic short-axis view of the left ventricle was performed intraoperatively in 11 patients undergoing elective coronary artery bypass surgery. After injection of 2 ml of sonicated lopromid (Ultravist 370) into 14 vein grafts, contrast enhancement in the corresponding myocardial regions was clearly visible, no side-effects occurred. Contrast decay halftimes (T/2) were determined by computer-assisted videodensitometry and compared to electromagnetic flow (EMF) rates, which were measured immediately before. T/2 ranged from 2.1 to 6.9 (mean 4.1 +/- 1.5) s and did not correlate to the EMF-rates of 55 to 100 (mean 80 +/- 16) ml/min. Thus intraoperative myocardial echocardiography is a safe and feasible method which allows on-line visualization and off-line quantitation of regional myocardial perfusion intraoperatively.
为了尽量降低心肌血运重建不充分的发生率，术中对局部心肌灌注进行评估可能具有实际意义。目前的旁路血流测量存在固有局限性，只能测定心外膜血流。为分析局部移植依赖的心肌血流，对11例接受择期冠状动脉旁路手术的患者在术中进行了左心室超声心动图短轴视图检查。向14条静脉移植物内注射2 ml超声处理的洛普酰胺（优维显370）后，相应心肌区域的造影剂增强清晰可见，未出现副作用。通过计算机辅助视频密度测定法确定造影剂衰减半衰期（T/2），并与之前立即测量的电磁血流（EMF）速率进行比较。T/2范围为2.1至6.9（平均4.1±1.5）秒，与55至100（平均80±16）ml/min的EMF速率不相关。因此，术中心肌超声心动图是一种安全可行的方法，可在术中对局部心肌灌注进行在线可视化和离线定量分析。
