Caspi J, Herman S L, Wilson G J, Villamater J, Augustine J, Hamilton F, Castellarin S, Kumar R, Benson L N, Coles J G
Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
J Heart Transplant. 1990 Jul-Aug;9(4):435-40.
The function and survival of the autoperfused working heart-lung preparation in the newborn period was studied in six newborn pigs (3 to 5 days old). Normothermic autoperfusion was maintained by a closed blood-primed circuit. Left ventricular afterload was determined by positioning the blood reservoir, and the venous return was adjusted to maintain a right atrial pressure of 6 to 8 mm Hg. Left ventricular function was assessed by a conductance catheter in the left ventricle and was determined by the slope of the end-systolic pressure-volume relationship. Left ventricular diastolic compliance was measured from the end-diastolic pressure-volume relationship. Serial measurements at 60, 120, 180, and 240 minutes showed no change in the end-systolic pressure-volume relationship, whereas there was a significant leftward shift of the end-diastolic pressure-volume relationship after 240 minutes (0.42 +/- 0.02 ml-1 to 0.66 +/- 0.04 ml-1, p less than 0.05). Cessation of effective cardiac function occurred at 268 +/- 10 minutes (+/- SEM). This followed progressive deterioration in pulmonary function based on measurement of arterial blood gases and peak airway resistance. This study shows the feasibility of maintaining systolic cardiac function in a newborn autoperfused working heart-lung preparation. Extended survival beyond 4 hours will require improved methods to preserve left ventricular diastolic function and especially pulmonary function.
对6头新生猪（3至5日龄）的新生儿期自体灌注工作心肺制备物的功能和存活情况进行了研究。通过封闭的血液预充回路维持常温自体灌注。通过放置储血器来确定左心室后负荷，并调节静脉回流以维持右心房压力在6至8 mmHg。通过左心室内的电导导管评估左心室功能，并根据收缩末期压力-容积关系的斜率来确定。从舒张末期压力-容积关系测量左心室舒张顺应性。在60、120、180和240分钟时的系列测量显示，收缩末期压力-容积关系无变化，而240分钟后舒张末期压力-容积关系有显著的向左移位（从0.42±0.02 ml-1至0.66±0.04 ml-1，p<0.05）。有效心脏功能在268±10分钟（±SEM）时停止。这是在基于动脉血气和气道峰值阻力测量的肺功能逐渐恶化之后发生的。本研究表明在新生儿自体灌注工作心肺制备物中维持收缩期心脏功能的可行性。超过4小时的延长存活将需要改进方法来保存左心室舒张功能，尤其是肺功能。
