DeCampli William M, Secasanu Virgil, Argueta-Morales I Ricardo, Cox Kelly, Ionan Constantine, Kassab Alain J
The Heart Center at Arnold Palmer Hospital for Children, Orlando, FL, USA College of Medicine at the University of Central Florida, Orlando, FL, USA College of Engineering and Computer Science, University of Central Florida, Mechanical and Aerospace Engineering, Orlando, FL, USA
College of Medicine at the University of Central Florida, Orlando, FL, USA.
World J Pediatr Congenit Heart Surg. 2015 Jan;6(1):75-82. doi: 10.1177/2150135114558850.
Systemic-to-pulmonary artery shunt (SPS) palliation reduces coronary blood flow (CBF), which may precipitate myocardial ischemia postoperatively.
Counterpulsation (CP) of SPS augments CBF.
Seven neonatal piglets (4.3 ± 0.23 kg) underwent sternotomy and ductus ligation. With a 5-mm polytetrafluoroethylene graft, SPS was created from innominate to pulmonary artery. A rigid shell holding a 9.5-mm diameter balloon was placed around the graft for CP. Using electrocardiographic signal, CP was initiated to trigger balloon inflation/deflation during the diastolic/systolic intervals, respectively. Instantaneous proximal and distal pulmonary artery and mid-anterior descending coronary artery flow rates were measured using transit time flow probes. Blood pressure and flow rates were recorded during three states: shunt closed, shunt open, and shunt open with CP.
Friedman's test and repeated measures analysis of variance.
Diastolic pressure decreased significantly with the shunt open (39 ± 8.4 to 28 ± 4.5 mm Hg, P = .05), then increased with CP (33 ± 2.3 mm Hg, P = .03). Median ratio of pulmonary to systemic flow (Qp/Qs) was 1.19, 1.9, and 1.53 with shunt closed, open, and open with CP, respectively. With CP, both diastolic coronary flow per minute (P = .018) and average diastolic flow rate per diastolic interval (P = .03) increased as well as total coronary flow per minute (P = .066; 19.6% ± 11.7%, 25.2% ± 17.0%, and 15.4% ± 13.9% change from shunt open, respectively). The percentage increase in average diastolic flow rate per diastolic interval correlated strongly with Qp/Qs (R (2) = .838).
In this model of SPS, CP increased diastolic blood pressure and CBF while maintaining significant augmentation of pulmonary blood flow (Qp/Qs). Shunt CP may aid in early postoperative management of palliative congenital heart disease.
体循环至肺动脉分流术（SPS）姑息治疗会减少冠状动脉血流量（CBF），这可能会在术后引发心肌缺血。
SPS的反搏（CP）可增加CBF。
七只新生仔猪（4.3±0.23千克）接受胸骨切开术和动脉导管结扎术。使用5毫米的聚四氟乙烯移植物，建立无名动脉至肺动脉的SPS。在移植物周围放置一个装有直径9.5毫米球囊的硬壳用于CP。利用心电图信号，分别在舒张期/收缩期启动CP以触发球囊充气/放气。使用渡越时间血流探头测量近端和远端肺动脉以及前降支冠状动脉的瞬时血流速率。在三种状态下记录血压和血流速率：分流关闭、分流开放、分流开放并进行CP。
弗里德曼检验和重复测量方差分析。
分流开放时舒张压显著降低（从39±8.4降至28±4.5毫米汞柱，P = 0.05），然后CP时升高（33±2.3毫米汞柱，P = 0.03）。分流关闭、开放、开放并进行CP时肺循环与体循环血流量比值（Qp/Qs）的中位数分别为1.19、1.9和1.53。进行CP时，每分钟舒张期冠状动脉血流量（P = 0.018）、每个舒张期平均舒张期血流速率（P = 0.03）以及每分钟冠状动脉总血流量均增加（P = 0.066；与分流开放相比分别变化19.6%±11.7%、25.2%±17.0%和15.4%±13.9%）。每个舒张期平均舒张期血流速率的增加百分比与Qp/Qs密切相关（R² = 0.838）。
在该SPS模型中，CP增加了舒张压和CBF，同时维持了肺血流量（Qp/Qs）的显著增加。分流CP可能有助于姑息性先天性心脏病的术后早期管理。
