Chen X Z, Shardey G C, Rosenfeldt F L
Baker Medical Research Institute, Prahran, Victoria, Australia.
Ann Thorac Surg. 1988 Oct;46(4):401-5. doi: 10.1016/s0003-4975(10)64652-8.
We developed a technique for selectively cooling the right heart during cardioplegic arrest by intracavitary right atrial (RA) perfusion with cold blood. In dogs during hypothermic cardioplegic arrest, we compared the effects on myocardial temperature of RA perfusion and two snared caval cannulas with three methods of venous cannulation without perfusion: a two-stage atriocaval cannula, two caval cannulas and two snared caval cannulas. The mean atrioventricular (AV) node temperature with RA perfusion (16.5 degrees +/- 0.4 degrees C) was significantly lower than with the atriocaval cannula (25.1 degrees +/- 0.2 degrees C), two caval cannulas (25.2 degrees +/- 0.3 degrees C) or two snared caval cannulas (21.6 degrees +/- 0.2 degrees C) (p less than 0.01, RA perfusion versus other groups). The results for RA wall temperature showed a similar pattern. RA perfusion produced similar results in 6 patients undergoing coronary artery bypass grafting. We conclude that hypothermic protection of the right atrium and AV node is inadequate with conventional techniques of cannulation and cooling, and may be improved by the use of internal RA cooling.
我们开发了一种技术，通过右心房腔内冷血灌注在心脏停搏期间选择性冷却右心。在低温心脏停搏期间的犬类实验中，我们比较了右心房灌注和两种圈套腔静脉插管对心肌温度的影响，以及三种无灌注静脉插管方法的影响：两阶段心房腔静脉插管、两个腔静脉插管和两个圈套腔静脉插管。右心房灌注时平均房室（AV）结温度（16.5摄氏度±0.4摄氏度）显著低于心房腔静脉插管（25.1摄氏度±0.2摄氏度）、两个腔静脉插管（25.2摄氏度±0.3摄氏度）或两个圈套腔静脉插管（21.6摄氏度±0.2摄氏度）（p<0.01，右心房灌注与其他组相比）。右心房壁温度结果显示出类似模式。右心房灌注在6例接受冠状动脉旁路移植术的患者中产生了类似结果。我们得出结论，传统的插管和冷却技术对右心房和房室结的低温保护不足，使用右心房内部冷却可能会有所改善。
