Hoit B D, Fowler N O
University of Cincinnati Medical Center, Division of Cardiology, Ohio 45267-0542.
J Am Coll Cardiol. 1991 Dec;18(7):1787-93. doi: 10.1016/0735-1097(91)90522-b.
Echocardiographic and hemodynamic data were measured in nine closed chest dogs during graded cardiac tamponade (pericardial pressure 5, 10, 15 mm Hg) before and after production of diffuse acute ischemic right ventricular dysfunction. Right ventricular dysfunction was produced by intracoronary injection of nonradioactive microspheres (mean diameter +/- SD 54 +/- 4 microns) and caused a significant increase in right atrial pressure (7.6 +/- 1.4 vs. 1.6 +/- 1 mm Hg, p less than 0.001) and cross-sectional areas of both the right atrium (8.3 +/- 0.3 vs. 5.6 +/- 0.2 cm2, p less than 0.001) and right ventricle (8.8 +/- 0.4 vs. 5.7 +/- 0.4 cm2, p less than 0.001). Right atrial and ventricular collapse required a significantly larger pericardial effusion and pericardial pressure after right ventricular infarction than before. Mean aortic pressure had fallen 1.9 +/- 2% and 6.5 +/- 6.9% at the time of right atrial collapse (p = NS before vs. after right ventricular dysfunction) and 3 +/- 4.1% and 20.1 +/- 20.8% at the time of right ventricular collapse (p less than 0.03) before and after right ventricular dysfunction, respectively. In the presence of ischemic right ventricular dysfunction, echocardiographic signs of cardiac tamponade are less sensitive and occur later in the hemodynamic progression of cardiac tamponade. Pulsus paradoxus with cardiac tamponade was not prevented by coexisting ischemic right ventricular dysfunction.
在9只开胸犬身上测量了超声心动图和血流动力学数据，这些犬在分级心包填塞（心包压力5、10、15 mmHg）期间，在产生弥漫性急性缺血性右心室功能障碍之前和之后进行测量。通过冠状动脉内注射非放射性微球（平均直径±标准差54±4微米）产生右心室功能障碍，导致右心房压力显著升高（7.6±1.4 vs. 1.6±1 mmHg，p<0.001）以及右心房（8.3±0.3 vs. 5.6±0.2 cm²，p<0.001）和右心室（8.8±0.4 vs. 5.7±0.4 cm²，p<0.001）的横截面积显著增加。与之前相比，右心室梗死之后右心房和心室塌陷需要更大的心包积液和心包压力。右心房塌陷时平均主动脉压下降了1.9±2%和6.5±6.9%（右心室功能障碍前后比较，p=无显著性差异），右心室塌陷时分别下降了3±4.1%和2±0.8%（p<0.03），分别在右心室功能障碍之前和之后。在存在缺血性右心室功能障碍的情况下，心包填塞的超声心动图征象敏感性较低，且在心包填塞的血流动力学进展中出现较晚。同时存在的缺血性右心室功能障碍并不能预防心包填塞时的奇脉。
