Argiriou Mihalis, Mikroulis Dimitrios, Sakellaridis Timothy, Didilis Vasilios, Papalois Apostolos, Bougioukas George
Second Cardiac Surgery Department, Evaggelismos General Hospital, 45-47 Ipsilantou, 10676 Athens, Greece.
J Cardiothorac Surg. 2011 Oct 19;6:143. doi: 10.1186/1749-8090-6-143.
In right ventricular failure (RVF), an interatrial shunt can relieve symptoms of severe pulmonary hypertension by reducing right ventricular preload and increasing systemic flow. Using a pig model to determine if a pulmonary artery-left atrium shunt (PA-LA) is better than a right atrial-left atrial shunt (RA-LA), we compared the hemodynamic effects and blood gases between the two shunts.
Thirty, male Large White pigs weighting in average 21.3 kg ± 0.7 (SEM) were divided into two groups (15 pigs per group): In group 1, banding of the pulmonary artery and a pulmonary artery to left atrium shunt with an 8 mm graft (PA-LA) was performed and in group 2 banding of the pulmonary artery and right atrial to left atrial shunt (RA-LA) with a similar graft was performed. Hemodynamic parameters and blood gases were measured from all cardiac chambers in 10 and 20 minutes, half and one hour interval from the baseline (30 min from the banding). Cardiac output and flow of at the left anterior descending artery was also monitored.
In both groups, a stable RVF was generated. The PA-LA shunt compared to the RA-LA shunt has better hemodynamic performance concerning the decreased right ventricle afterload, the 4 fold higher mean pressure of the shunt, the better flow in left anterior descending artery and the decreased systemic vascular resistance. Favorable to the PA-LA shunt is also the tendency--although not statistically significant--in relation to central venous pressure, left atrial filling and cardiac output.
The PA-LA shunt can effectively reverse the catastrophic effects of acute RVF offering better hemodynamic characteristics than an interatrial shunt.
在右心室衰竭（RVF）中，心房分流可通过降低右心室前负荷和增加体循环血流量来缓解严重肺动脉高压的症状。我们使用猪模型来确定肺动脉-左心房分流（PA-LA）是否优于右心房-左心房分流（RA-LA），比较了两种分流的血流动力学效应和血气情况。
30只平均体重为21.3 kg±0.7（标准误）的雄性大白猪被分为两组（每组15只）：第1组进行肺动脉结扎并使用8 mm移植物建立肺动脉-左心房分流（PA-LA），第2组进行肺动脉结扎并使用类似移植物建立右心房-左心房分流（RA-LA）。在结扎后30分钟（基线）起，分别于10分钟、20分钟、半小时和1小时，测量所有心腔的血流动力学参数和血气。同时监测心输出量和左前降支的血流量。
两组均成功诱导出稳定的右心室衰竭。与RA-LA分流相比，PA-LA分流在降低右心室后负荷、分流平均压力高4倍、左前降支血流更好以及全身血管阻力降低方面具有更好的血流动力学表现。尽管在中心静脉压、左心房充盈和心输出量方面PA-LA分流虽无统计学意义但有改善趋势。
PA-LA分流可有效逆转急性右心室衰竭的灾难性影响，其血流动力学特征优于心房分流。
