Mudra H, Zwehl W, Klauss V, Kreuzer E, Haufe M C, Angermann C, Theisen K
Klinikum Innestadt, Grosshadern der Ludwig-Maximilians-Universität, Müchen, Federal Republic of Germany.
Am J Cardiol. 1990 Nov 1;66(15):1077-81. doi: 10.1016/0002-9149(90)90508-x.
The intraoperative determination of the success of surgical myocardial revascularization remains problematic because of major limitations in all currently used methods. To assess the regional blood flow of the bypass graft-dependent myocardial segments, 2 ml of sonicated iopromid (a nonionic x-ray contrast medium) was injected into the bypass graft in the beating heart. Simultaneously electromagnetic flow measurements were performed. Eleven graft injections in 8 men (mean age +/- standard deviation 60 +/- 4 years) were performed without any adverse effects. Excellent 2-dimensional cross-sectional views of the left ventricle were obtained in all cases. Ten of 11 injections resulted in adequate myocardial opacification. Computer-assisted evaluation by videodensitometry resulted in time-intensity curves with contrast decay half-times (T1/2) from 2.2 to 6.9 seconds (mean 4.3 +/- 1.4). The corresponding electromagnetic flow ranged from 55 to 100 ml/min (mean 80.0 +/- 16.2). there was no correlation between contrast 2-dimensional echocardiography-derived T1/2 and electromagnetic flow (r = 0.32; p = 0.38). Thus, myocardial contrast echocardiography is a feasible and safe method for intraoperative evaluation of the success of bypass graft surgery. It offers online visualization of perfusion of revascularized myocardium and may allow immediate intraoperative revision of unsuccessful bypass graft placement.
由于目前所有使用方法都存在重大局限性，手术心肌血运重建成功与否的术中判定仍然存在问题。为了评估依赖搭桥移植的心肌节段的局部血流，在跳动的心脏中将2毫升经超声处理的碘普罗胺（一种非离子型X线造影剂）注入搭桥移植血管。同时进行电磁血流测量。对8名男性（平均年龄±标准差60±4岁）进行了11次移植血管注射，未出现任何不良反应。所有病例均获得了左心室出色的二维横截面图像。11次注射中有10次使心肌显影充分。通过视频密度测定法进行计算机辅助评估得出的时间-强度曲线，其对比剂衰减半衰期（T1/2）为2.2至6.9秒（平均4.3±1.4）。相应的电磁血流范围为55至100毫升/分钟（平均80.0±16.2）。二维超声心动图得出的对比剂T1/2与电磁血流之间无相关性（r = 0.32；p = 0.38）。因此，心肌对比超声心动图是术中评估搭桥移植手术成功与否的一种可行且安全的方法。它可在线显示血运重建心肌的灌注情况，并可能允许在术中立即对不成功的搭桥移植血管放置进行修正。
