Rousseau M F, Wyns W, Hammer F, Caucheteux D, Hue L, Pouleur H
Cardiac Catheterization and Interventional Cardiology Unit, St. Luc University Hospital, Brussels, Belgium.
Am J Cardiol. 1988 May 1;61(13):1080-4. doi: 10.1016/0002-9149(88)90130-0.
The effects of balloon inflation on myocardial perfusion and metabolism were studied during aortic valvuloplasty in 17 patients with aortic stenosis, including 6 with associated coronary artery disease. Coronary sinus flow and blood samples were obtained before and during the first inflation, and 5 to 10 minutes after the last inflation. During inflation, coronary blood flow decreased (272 +/- 111 standard deviation to 166 +/- 92 ml/min; p less than 0.05), myocardial oxygen uptake fell and transcardiac lactate handling shifted from extraction to production (35 +/- 54 to -41 +/- 48 mumol/min; p less than 0.01). At the end of the procedure, aortic valve area had increased from 0.51 +/- 0.22 to 0.81 +/- 0.48 cm2 (p less than 0.002). Coronary sinus flow increased slightly above control values (+6%; difference not significant) and myocardial oxygen and lactate uptakes were back to control values. However, myocardial alanine production had increased from -3.6 to -6.6 mumol/min (p less than 0.05) and glutamine production was reduced or replaced by extraction (-3.3 +/- 2.1 to 3.5 +/- 3.8 mumol/min; p less than 0.05). Recovery of coronary flow, oxygen and lactate uptakes was not significantly different in patients with or without coronary artery disease, although the former patients tended to have less glutamine extraction and less improvement in their ejection fraction at the end of the procedure. Thus, aortic balloon valvuloplasty produces brief episodes of low-flow ischemia. Recovery of oxidative metabolism is almost immediate after deflation and no detrimental effect seems to persist at the end of the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
在17例主动脉瓣狭窄患者（其中6例合并冠状动脉疾病）的主动脉瓣成形术中，研究了球囊充盈对心肌灌注和代谢的影响。在首次充盈前、充盈期间以及最后一次充盈后5至10分钟采集冠状窦血流和血样。充盈期间，冠状动脉血流量减少（从272±111标准差降至166±92 ml/分钟；p<0.05），心肌摄氧量下降，经心脏的乳酸处理从摄取转变为生成（从35±54至-41±48 μmol/分钟；p<0.01）。手术结束时，主动脉瓣面积从0.51±0.22增加至0.81±0.48 cm²（p<0.002）。冠状窦血流略高于对照值增加（+6%；差异不显著），心肌氧摄取和乳酸摄取恢复至对照值。然而，心肌丙氨酸生成从-3.6增加至-6.6 μmol/分钟（p<0.05），谷氨酰胺生成减少或被摄取取代（从-3.3±2.1至3.5±3.8 μmol/分钟；p<0.05）。有或无冠状动脉疾病的患者，冠状动脉血流、氧摄取和乳酸摄取的恢复无显著差异，尽管前者患者在手术结束时谷氨酰胺摄取较少，射血分数改善较小。因此，主动脉球囊瓣膜成形术会产生短暂的低流量缺血发作。放气后氧化代谢几乎立即恢复，手术结束时似乎没有持续的有害影响。（摘要截短于250字）
