Menasché P, Kucharski K, Mundler O, Veyssié L, Subayi J B, Le Pimpec F, Fauchet M, Piwnica A
Department of Cardiovascular Surgery, Hôpital Lariboisière, Paris, France.
Circulation. 1989 Nov;80(5 Pt 2):III19-24.
Whether retrograde coronary sinus cardioplegia adequately preserves right ventricular (RV) function is still a point of concern. Using technetium Tc 99m-labeled red blood cells, we assessed global and segmental RV function by first-pass and gated blood-pool radionuclide angiocardiography before and within 24 hours after aortic valve replacement in 14 consecutive patients (age, 58 +/- 5 years; mean +/- SEM). Coronary sinus cardioplegia was given in a multidose fashion at a flow rate of 50-70 ml/min through a balloon-tipped catheter, with the inflated balloon kept seated around the intra-atrial rim of the coronary sinus orifice. Additional myocardial protection was provided by systemic (25 degrees C) and topical hypothermia. Postoperatively, none of the patients had clinical or hemodynamic patterns suggestive of RV dysfunction. The postoperative global RV ejection fraction (0.49 +/- 0.03) was similar to the preoperative value (0.49 +/- 0.01). Analysis of segmental wall motion did not reveal postoperative abnormalities of new onset in any of the three anatomically defined RV regions (free wall, apex, and septum). Similarly, RV end-diastolic and end-systolic volume indexes (ml/m2) were not significantly affected by coronary sinus cardioplegia, being 71.6 +/- 5.8 and 36.1 +/- 3.5 before, and 67.4 +/- 3.8 and 34.5 +/- 2.3 after aortic valve replacement, respectively. We conclude that retrograde coronary sinus cardioplegia does not cause a detectable impairment of RV function if the balloon catheter does not obstruct the terminal tributaries of the coronary sinus and, hence, does not impede delivery of cardioplegia to right-sided cardiac structures.
逆行冠状静脉窦停搏是否能充分保护右心室（RV）功能仍是一个备受关注的问题。我们使用锝 Tc 99m 标记的红细胞，通过首次通过和门控血池放射性核素血管造影术，在 14 例连续接受主动脉瓣置换术的患者（年龄 58±5 岁；平均值±标准误）术前及术后 24 小时内评估整体和节段性 RV 功能。通过带球囊导管以 50 - 70 ml/min 的流速多剂量给予冠状静脉窦停搏液，球囊充气后置于冠状静脉窦口的心房缘周围。通过全身（25℃）和局部低温提供额外的心肌保护。术后，没有患者出现提示 RV 功能障碍的临床或血流动力学模式。术后整体 RV 射血分数（0.49±0.03）与术前值（0.49±0.01）相似。对节段性壁运动的分析未发现术后在任何三个解剖学定义的 RV 区域（游离壁、心尖和室间隔）出现新的异常。同样，RV 舒张末期和收缩末期容积指数（ml/m²）未受到冠状静脉窦停搏的显著影响，主动脉瓣置换术前分别为 71.6±5.8 和 36.1±3.5，术后分别为 67.4±3.8 和 34.5±2.3。我们得出结论，如果球囊导管不阻塞冠状静脉窦的终末分支，从而不妨碍向右侧心脏结构输送停搏液，逆行冠状静脉窦停搏不会导致可检测到的 RV 功能损害。
