Brower R W, Serruys P W, Bos E, Nauta J
J Thorac Cardiovasc Surg. 1979 Jan;77(1):92-100.
Extent of regional shortening of myocardium in areas newly perfused by bypass grafting was determined in 56 patients by a new technique employing four to six radiopaque markers sutured in pairs to the epicardium near the coronary anastomosis. Paradoxical systolic expansion (PSE) was manifest in 16 regions (a 12% incidence) during the follow-up period, and six of these showed spontaneous remission. All cases of PSE were in the region of the left anterior descending artery. Correlation between graft flow measured during operation and regional shortening during the postoperative period revealed that the development of PSE could not be predicted from the hemodynamic measurements. In the majority of cases postoperative myocardial infarction could also be excluded as an explanation. At 1 year after operation most grafts were patent in PSE regions but collaterals, apparent preoperatively, could not be visualized. Excluding PSE, shortening fraction (ratio of shortening to maximum marker separation) for all graft regions at 1 week was 9.8%; 1 month, 12.8%; 3 months, 13.3%; and six months, 13.9%. Average graft flow was 56 ml. per minute and average reactive hyperemia was 25% with 37% of grafts showing no response. For those regions that did not develop PSE there was a positive correlation between shortening fraction and flow that became significant (null hypothesis: r = 0) when reactive hyperemia exceeded 20%. Correlation was greatest at 1 week and 1 month, but became nonsignificant at 6 months. These results are consistent with a simple interpretation of reactive hyperemia: Graft-reactive hyperemia is related to the dependence of viable tissue on the functioning of the graft.
采用一种新技术，在56例患者中测定了冠状动脉搭桥术后新灌注区域心肌的局部缩短程度。该技术是将四到六个不透射线的标记物成对缝合在冠状动脉吻合口附近的心外膜上。在随访期间，16个区域（发生率为12%）出现了矛盾性收缩期扩张（PSE），其中6个区域出现了自发缓解。所有PSE病例均发生在左前降支区域。手术期间测量的移植血管血流量与术后局部缩短之间的相关性表明，无法通过血流动力学测量预测PSE的发生。在大多数情况下，也可以排除术后心肌梗死作为解释。术后1年，大多数PSE区域的移植血管通畅，但术前可见的侧支血管无法显影。排除PSE后，所有移植区域在1周时的缩短分数（缩短与标记物最大间距的比值）为9.8%；1个月时为12.8%；3个月时为13.3%；6个月时为13.9%。平均移植血管血流量为每分钟56毫升，平均反应性充血为25%，37%的移植血管无反应。对于未发生PSE的区域，缩短分数与血流量之间存在正相关，当反应性充血超过20%时，这种相关性变得显著（原假设：r = 0）。相关性在1周和1个月时最大，但在6个月时变得不显著。这些结果与反应性充血的简单解释一致：移植血管反应性充血与存活组织对移植血管功能的依赖性有关。
