Laboratories of The Mount Sinai Hospital, New York.
J Exp Med. 1937 Jan 1;65(1):91-108. doi: 10.1084/jem.65.1.91.
Sudden occlusion of the left anterior descending branch approximately 2 cm. below the ostium of the left circumflex coronary artery in the dog's heart produces a mortality rate of approximately 50 per cent. In dogs weighing approximately 15 kilos surviving more than 24 hours (average 1 week), an infarction is produced which almost invariably measures 5 x 5 cm. on surface. Following coronary sinus obturation such secondary sudden occlusion of the left anterior descending branch is followed either by no infarction or by a reduction in the size of the infarct. The success of the procedure, quite apart from the mortality rate, depends upon the completeness of the coronary sinus obturation. On the other hand, sudden and complete coronary sinus obturation by itself is associated with a high operative mortality and apparently does not affect the mortality rate following subsequent sudden left anterior descending branch occlusion. Partial persistent obturation of the coronary sinus, however, is in itself associated with a low operative mortality. Furthermore, its experimental production in dogs appears to lower the mortality rate following subsequent sudden occlusion of the left anterior descending branch and to diminish the extent of the infarction. In the introduction to this report it was pointed out that there are three important desiderata to the problem of improving the coronary circulation in the human heart. The findings herein reported fulfill these requisites to an encouraging degree. It has been shown that following the outlined procedures, a functional increase in the blood supply to the heart can be produced in a significant proportion of experimental animals, this varying with the nature of the experimental procedure. The manipulation is simple, can be performed in the dog within approximately 20 minutes, and does not lead to appreciable pericardial adhesions. Increase in the nutrition of the myocardium is noted 1 week after the experimental procedure. Although no experiments employing sudden left anterior descending coronary branch occlusion were carried out sooner than 1 week, there is available anatomic evidence that within possibly 24 hours after coronary sinus occlusion a dilatation of the vascular bed occurs. In subsequent experiments attempts will be made to determine whether this early vascular dilatation is adequate to compensate for subsequent sudden left anterior descending branch occlusion. A discussion is given of the results following various coronary sinus occlusion procedures in which it is indicated that it is desirable to produce a partial or gradual occlusion in order to lower the mortality rate both of the initial procedure as well as of the subsequent sudden arterial occlusion. Experiments thus far reported on cardiopexy operations are lacking in evidence that they are associated with appreciable improvement in the vascular nutrition of the myocardium.
左前降支在犬心的回旋支口下方约 2 厘米处突然闭塞，其死亡率约为 50%。在体重约 15 公斤的犬中，24 小时以上（平均 1 周）存活者会发生梗塞，梗塞面积几乎总是为 5x5cm。在冠状窦阻塞后，左前降支的这种继发性突然闭塞要么不导致梗塞，要么导致梗塞面积减小。该手术的成功，完全不取决于死亡率，取决于冠状窦阻塞的完全性。另一方面，冠状窦的突然和完全阻塞本身与高手术死亡率相关，并且显然不会影响随后左前降支突然闭塞的死亡率。然而，冠状窦的部分持续阻塞本身与低手术死亡率相关。此外，在犬中实验性地产生它似乎会降低随后左前降支突然闭塞的死亡率，并减少梗塞的范围。在本报告的引言中指出，改善人心冠状动脉循环有三个重要的要求。本文报道的研究结果令人鼓舞地满足了这些要求。已经表明，按照概述的程序，可以在很大一部分实验动物中产生心脏血液供应的功能性增加，这取决于实验程序的性质。该操作简单，在犬中可以在大约 20 分钟内完成，并且不会导致明显的心包粘连。实验程序后 1 周即可观察到心肌营养增加。虽然没有进行早于 1 周的实验性左前降支闭塞的实验，但已有解剖学证据表明，在冠状窦闭塞后可能 24 小时内，血管床发生扩张。在随后的实验中，将尝试确定这种早期血管扩张是否足以补偿随后的左前降支突然闭塞。本文还讨论了各种冠状窦阻塞程序的结果，表明为了降低初始程序和随后的动脉突然闭塞的死亡率，产生部分或逐渐阻塞是可取的。迄今为止报告的心脏固定术实验缺乏与心肌血管营养明显改善相关的证据。
