Nakamura Y, Fukamachi K, Masuda M, Asou T, Toshima Y, Oe M, Mitani A, Kinoshita K, Kawachi Y, Tanaka J
Division of Cardiovascular Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
J Thorac Cardiovasc Surg. 1990 Feb;99(2):335-44.
Retrograde administration of cardioplegic solution via the right atrium with continuous cooling of the right ventricular cavity (right atrial perfusion cooling) was assessed for its protective effect in 12 dogs with occlusion of the right coronary artery subjected to global ischemia for 60 minutes. After an initial administration of 4 degrees C crystalloid cardioplegic solution by antegrade aortic perfusion, myocardial protection was established either by right atrial perfusion cooling (group I; n = 6) or by antegrade aortic perfusion alone (group II; n = 6). The right ventricular temperature was approximately 15 degrees C in group I and 20 degrees C in group II. After ischemia for 60 minutes, the adenosine triphosphate content of the right ventricular free wall was significantly higher in group I than in group II (24.4 +/- 1.45 versus 13.8 +/- 2.34 mumol/gm dry weight, p less than 0.05). The percent recovery of right ventricular contractility, which was evaluated by end-systolic pressure-volume relationships, was significantly better in group I at each reperfusion period (30 minutes: 130.0% +/- 9.6% versus 86.1% +/- 11.8%, p less than 0.05; 60 minutes: 159.6% +/- 12.9% versus 96.5% +/- 20.1%, p less than 0.05). Postischemic right ventricular stiffness (reciprocal value of compliance) increased in group II compared with group I, although the difference was not statistically significant. There were no major differences in percent recovery of the left ventricular end-systolic pressure-volume relationships between the two groups. The evidence suggests that the right atrial perfusion cooling method produces excellent right ventricular protection.
通过右心房逆行灌注心脏停搏液并持续冷却右心室腔（右心房灌注冷却），在12只右冠状动脉闭塞并经历60分钟全心缺血的犬中评估其保护作用。在通过顺行主动脉灌注首次给予4℃晶体心脏停搏液后，通过右心房灌注冷却（I组；n = 6）或仅通过顺行主动脉灌注（II组；n = 6）建立心肌保护。I组右心室温度约为15℃，II组为20℃。缺血60分钟后，I组右心室游离壁的三磷酸腺苷含量显著高于II组（24.4±1.45对13.8±2.34μmol/g干重，p<0.05）。通过收缩末期压力-容积关系评估的右心室收缩力恢复百分比，在每个再灌注期I组均显著更好（30分钟：130.0%±9.6%对86.1%±11.8%，p<0.05；60分钟：159.6%±12.9%对96.5%±20.1%，p<0.05）。与I组相比，II组缺血后右心室僵硬度（顺应性的倒数）增加，尽管差异无统计学意义。两组之间左心室收缩末期压力-容积关系的恢复百分比无重大差异。证据表明，右心房灌注冷却方法可产生出色的右心室保护作用。
