Trubel W, Wieselthaler G, Buxbaum P, Rokitansky A, Schima H, Schreiner W, Vierhapper H, Waldhäusl W K, Losert U M, Wolner E
Department of Surgery, General Hospital of Vienna, University of Vienna, Austria.
ASAIO Trans. 1989 Jul-Sep;35(3):718-21. doi: 10.1097/00002480-198907000-00178.
In 5 total artificial heart (TAH)-bridge-to-transplant (BTT) patients production and secretion of atrial natriuretic factor (ANF)1 was studied before, during, and after TAH implantation. Bridging periods lasted between 9 and 28 days. Atrial biopsies were taken during implantation, and after TAH explantation for histologic and histochemical investigations to evaluate differences in morphology and ANF-content of the specific atrial granules. Plasma concentrations of ANF (pANF), aldosterone (PAC) and renin (PRC) were measured daily, as were hemodynamic parameters. In the preoperative state, pANF was always markedly elevated, while during TAH bridging, pANF remained moderately elevated with fluctuations. A positive correlation between pANF levels and right atrial pressure (RAP) was seen in all patients (p less than 0.05). Slight correlation was also observed between pANF and left atrial pressure (LAP), but no correlation was seen between pANF and systemic blood pressure, and no consistent pattern was seen in the plasma concentrations of either renin or aldosterone. After heart transplantation (HTX), which was performed in 3 patients, pANF levels were significantly higher than during TAH, and continued to show a positive correlation with RAP. From our data, we conclude that ANF production sites and secretory mechanisms remain intact during TAH-bridging, although upon implantation of a TAH, the remaining atria are deprived of all coronary blood supply and most autonomic innervation.
在5例接受全人工心脏（TAH）过渡到心脏移植（BTT）的患者中，研究了TAH植入前、植入期间和植入后的心房利钠因子（ANF）1的产生和分泌情况。过渡时间为9至28天。在植入期间及TAH取出后进行心房活检，用于组织学和组织化学研究，以评估特定心房颗粒的形态和ANF含量的差异。每天测量血浆中ANF（pANF）、醛固酮（PAC）和肾素（PRC）的浓度以及血流动力学参数。术前状态下，pANF始终显著升高，而在TAH过渡期间，pANF保持中度升高且有波动。所有患者的pANF水平与右心房压力（RAP）之间均呈正相关（p<0.05）。pANF与左心房压力（LAP）之间也观察到轻微相关性，但pANF与体循环血压之间无相关性，肾素或醛固酮的血浆浓度也无一致模式。3例患者接受心脏移植（HTX）后，pANF水平显著高于TAH期间，并继续与RAP呈正相关。根据我们的数据，我们得出结论，在TAH过渡期间，ANF的产生部位和分泌机制保持完整，尽管植入TAH后，剩余心房被剥夺了所有冠状动脉血供和大部分自主神经支配。
