Diehl J T, Kaplan E, Dresdale A R, Kreis A, Konstam M A, Ross I M, Connolly R J, Pandian N G, Aronovitz M, Payne D D
Division of Cardiothoracic Surgery and Cardiology, New England Medical Center Hospitals, Boston, MA 02111.
Ann Thorac Surg. 1989 Dec;48(6):829-34. doi: 10.1016/0003-4975(89)90680-2.
Right atrial cardioplegia has been advocated as a simple method of delivering retrograde cardioplegia. Passive distention of the right heart inherent with right atrial cardioplegia has been shown to impair right ventricular function in a canine model of global ischemia. This study was designed to compare right ventricular performance after right atrial cardioplegia administered intermittently (n = 5) and continuously (n = 5) with coronary sinus retrograde cardioplegia (n = 5) and aortic root cardioplegia (n = 8) in a canine model of acute right ventricular ischemia and reperfusion. Right ventricular performance was assessed using the load-independent relationship of end-systolic pressure versus dimension (myocardial fiber length). Right ventricular performance was well preserved after reperfusion in those dogs protected with intermittent right atrial cardioplegia (95% of control). Results with continuous right atrial cardioplegia (66% of control) and coronary sinus retrograde cardioplegia (40% of control) demonstrated diminished postreperfusion right ventricular performance. Right ventricular performance in the group protected with aortic root cardioplegia was significantly impaired after reperfusion when compared with all retrograde groups (34% of control, p less than 0.05). In this model, postreperfusion right ventricular performance was preserved in the right atrial cardioplegia groups despite passive ventricular distention. All methods of retrograde cardioplegia resulted in superior preservation of right ventricular performance when compared with standard aortic root cardioplegia.
右心房心肌停搏已被提倡作为一种简单的逆行心肌停搏给药方法。在全球缺血的犬模型中，右心房心肌停搏固有的右心被动扩张已被证明会损害右心室功能。本研究旨在比较在急性右心室缺血和再灌注的犬模型中，间歇性（n = 5）和持续性（n = 5）给予右心房心肌停搏、冠状静脉窦逆行心肌停搏（n = 5）和主动脉根部心肌停搏（n = 8）后右心室的功能。使用收缩末期压力与尺寸（心肌纤维长度）的负荷无关关系来评估右心室功能。在用间歇性右心房心肌停搏保护的犬中，再灌注后右心室功能得到良好保留（为对照的95%）。持续性右心房心肌停搏（为对照的66%）和冠状静脉窦逆行心肌停搏（为对照的40%）的结果表明，再灌注后右心室功能降低。与所有逆行组相比，用主动脉根部心肌停搏保护的组在再灌注后右心室功能明显受损（为对照的34%，p < 0.05）。在该模型中，尽管存在心室被动扩张，但右心房心肌停搏组在再灌注后右心室功能得以保留。与标准主动脉根部心肌停搏相比，所有逆行心肌停搏方法在右心室功能保留方面均更优。
