Hoshino R
Nihon Kyobu Geka Gakkai Zasshi. 1989 Jul;37(7):1287-96.
Anterior cardiac veins which are the main drainage vessels of the right ventricle drain directly into the right atrium. Therefore, the right ventricular wall may not be perfused effectively during open heart surgery by the use of retrograde cardioplegic method resulting in postoperative right ventricular dysfunction. Seventeen mongrel dogs were subjected to this study and were placed on cardiopulmonary bypass using a conventional heart-lung machine. Total aortic cross-clamping time was 60 minutes in all dogs. In Group I (n = 6), 4 degrees C St. Thomas' Hospital solution (15 ml/kg body weight) was injected into the aortic root by the use of a syringe. Cardioplegic solution was replenished every 20 minutes with a half of the initial dose (7.5 ml/kg body weight). Group II (n = 6) were the dogs with the retrograde cardioplegia in which 4 degrees C St. Thomas' Hospital solution (15 ml/kg body weight) was given retrogradely from the coronary sinus by the drip method at the height of 60 cm, and the replenishing dose and interval of cardioplegia were the same as Group I. Group III (n = 5) was the dogs treated with retrograde cardioplegia identical to Group II and the combined use of topical cooling with ice-slush. The hearts were resuscitated after 60 minutes of aortic cross-clamping. Right ventricular functions such as cardiac output, right atrial pressure, right ventricular end-diastolic pressure, right ventricular max dp/dt, and shortening fraction of the right ventricle were measured 15, 30, 45, and 60 minutes after cardiac resuscitation respectively. In Group II, right atrial pressure was significantly elevated from the control value 15 and 30 minutes after cardiac resuscitation. On the other hand, all indices of right ventricular functions in Group III showed insignificant changes. The present experimental study demonstrated the retrograde cardioplegic method could produce right ventricular perfusion resulting in right ventricular dysfunction early after cardiac resuscitation. This deleterious effect however could be prevented by the combined use of topical cooling of the right ventricle with ice-slush.
心前静脉是右心室的主要引流血管，直接引流至右心房。因此，在心脏直视手术中，采用逆行心脏停搏法可能无法有效地灌注右心室壁，从而导致术后右心室功能障碍。本研究选用17只杂种犬，使用传统心肺机进行体外循环。所有犬的主动脉全阻断时间均为60分钟。第一组（n = 6），用注射器将4℃的圣托马斯医院溶液（15 ml/kg体重）注入主动脉根部。每隔20分钟补充一次心脏停搏液，补充剂量为初始剂量的一半（7.5 ml/kg体重）。第二组（n = 6）为采用逆行心脏停搏的犬，通过滴注法在60 cm高度从冠状窦逆行给予4℃的圣托马斯医院溶液（15 ml/kg体重），心脏停搏液的补充剂量和间隔与第一组相同。第三组（n = 5）为采用与第二组相同的逆行心脏停搏并联合使用冰屑局部降温的犬。主动脉阻断60分钟后使心脏复苏。分别在心脏复苏后15、30、45和60分钟测量右心室功能，如心输出量、右心房压力、右心室舒张末期压力、右心室最大dp/dt以及右心室缩短分数。在第二组中，心脏复苏后15和30分钟，右心房压力较对照值显著升高。另一方面，第三组右心室功能的所有指标变化均不显著。本实验研究表明，逆行心脏停搏法可导致右心室灌注，从而在心脏复苏后早期引起右心室功能障碍。然而，通过联合使用冰屑对右心室进行局部降温可预防这种有害作用。
