Kondo Y, Hanya S, Hiyama T, Ishihara A
Department of Thoracic and Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1990 Dec;38(12):2385-9.
It has not been established that Bentall's operation induces beneficial effect on a coronary circulation in a patient with Annulo-Aortic-Ectasia. Availability of a small subselective coronary Doppler catheter makes it possible to study the effects of the operation on coronary circulation. In a 49 year old man with Annulo-Aortic-Ectasia, phasic coronary flow velocity in the left main truncus was measured using a 3F steerable Doppler catheter (DC-101, Millar Inc.) pre- and postoperatively with assessment of vasodilator reserve capacity of individual coronary arteries. After the operation, the velocity wave form in the LMT changed to a diastolic-predominant normal pattern with a relatively small systolic component. That is, Bentall's operation caused a marked reduction of systolic- to diastolic flow component ratio from 0.32 to 0.19. The postoperative coronary flow configuration in the LMT was characterized by the presence of predominant diastolic spike. It coincided with "Water hammer wave" in the aortic pressure tracings caused by sudden closing of mechanical valve leaflets. Preoperative intracoronary papaverine increased the ratio of peak to resting velocity (coronary flow reserve) to 2.0 times at the rest, and 3.0 times after the operation. These results suggest that Bentall's operation seems to induce beneficial effect on the myocardial coronary circulation.
目前尚未证实Bentall手术对主动脉瓣环扩张症患者的冠状动脉循环有有益影响。小型亚选择性冠状动脉多普勒导管的出现使得研究该手术对冠状动脉循环的影响成为可能。在一名49岁的主动脉瓣环扩张症男性患者中，使用3F可操纵多普勒导管（DC - 101，Millar公司）在术前和术后测量左主干的时相性冠状动脉血流速度，并评估各冠状动脉的血管舒张储备能力。术后，左主干的速度波形转变为以舒张期为主的正常模式，收缩期成分相对较小。也就是说，Bentall手术使收缩期与舒张期血流成分比从0.32显著降低至0.19。术后左主干的冠状动脉血流形态以明显的舒张期尖峰为特征。这与机械瓣膜叶突然关闭引起的主动脉压力描记图中的“水锤波”一致。术前冠状动脉内注射罂粟碱使静息时峰值与静息速度之比（冠状动脉血流储备）增加到2.0倍，术后增加到3.0倍。这些结果表明，Bentall手术似乎对心肌冠状动脉循环有有益影响。
