Okumura H
Second Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Feb;39(2):174-82.
It has been known that the ventricular assist device (VAD) is effective in profound ventricular failure refractory to conventional drugs and the intra-aortic balloon pumping. The patients with biventricular failure required biventricular mechanical support for survival. Until recently, biventricular assist device (BVAD) were applied in a few instances unfortunately. In this experimental study biventricular failure was induced by pulmonary artery banding and ligation of left anterior descending coronary artery in 20 pigs, and the BVAD was operated and the optimal driving mode was examined on the flow ratio of the right and left pumps. Group I animals were treated with BVAD, in the condition pump flow ratio right ventricular assist device (RVAD): left ventricular assist device (LVAD) = 1: less than 0.5 (4 pigs), group II were RVAD:LVAD = 1:0.5 less than or equal to less than 1 (8 pigs), and group III were RVAD:LVAD = 1:1 less than or equal to (8 pigs). CVP and RVEDP were decreased by operating the BVAD in all groups. In the group I, the flow of LVAD was less than a half of that of RVAD and the condition of excess left ventricular preload was elicited, and left ventricular failure was accelerated and it was difficult to maintain the systemic circulation. In contrast, in group II and III, the left ventricular preload was decreased, and left ventricular failure improved, and it was maintain the systemic circulation. PCWP/CVP was calculated as a method to determine clinically the right and left pump flow.(ABSTRACT TRUNCATED AT 250 WORDS)
已知心室辅助装置(VAD)对常规药物和主动脉内球囊反搏治疗无效的严重心室衰竭有效。双心室衰竭患者需要双心室机械支持才能存活。直到最近,双心室辅助装置(BVAD)仅在少数情况下应用。在本实验研究中,通过对20头猪进行肺动脉环扎和左前降支冠状动脉结扎诱导双心室衰竭,然后植入BVAD并根据左右泵的流量比检查最佳驱动模式。I组动物接受BVAD治疗,泵流量比为右心室辅助装置(RVAD):左心室辅助装置(LVAD)=1:小于0.5(4头猪),II组为RVAD:LVAD = 1:0.5至小于1(8头猪),III组为RVAD:LVAD = 1:1及以上(8头猪)。所有组通过操作BVAD使中心静脉压(CVP)和右心室舒张末期压力(RVEDP)降低。在I组中,LVAD的流量小于RVAD的一半,引发左心室前负荷过重的情况,加速了左心室衰竭,难以维持体循环。相比之下,在II组和III组中,左心室前负荷降低,左心室衰竭改善,能够维持体循环。计算肺毛细血管楔压/中心静脉压(PCWP/CVP)作为临床确定左右泵流量的方法。(摘要截断于250字)