Teoh K H, Mullen J C, Weisel R D, Christakis G T, Madonik M M, Ivanov J, Mickle D A
Division of Cardiovascular Surgery, Toronto General Hospital, Ontario, Canada.
J Thorac Cardiovasc Surg. 1988 Nov;96(5):725-9.
Current methods of cardioplegic delivery may delay the recovery of right ventricular metabolism and function. To evaluate right and left ventricular metabolism, we performed biopsies in 37 patients undergoing elective coronary bypass operation with aortic root blood cardioplegia. Right ventricular temperatures were warmer than left ventricular temperatures during cardioplegic arrest (right ventricle: 16.8 degrees +/- 3.8 degrees C, left ventricle: 14.3 degrees +/- 3.7 degrees C, p = 0.02). Adenosine triphosphate concentrations were lower in the right ventricle than in the left ventricle before cardioplegic arrest (right ventricle: 13.8 +/- 7.8 mmol/kg, left ventricle: 21.5 +/- 8.7 mmol/kg, p = 0.02). After reperfusion, right ventricular adenosine triphosphate concentrations fell to low levels (10 +/- 6 mmol/kg). Postoperative left and right ventricular high energy phosphate concentrations (the sum of adenosine triphosphate and creatine phosphate levels) correlated inversely with myocardial temperatures during cardioplegia (r = -0.29, p = 0.048). Aortic root cardioplegia did not cool the right ventricle as well as it did the left ventricle. The lower preoperative high energy phosphate concentrations may have increased the susceptibility of the right ventricle to ischemic injury. Alternative methods of myocardial preservation may improve right ventricular cooling and protection.
目前的心脏停搏液灌注方法可能会延迟右心室代谢和功能的恢复。为了评估左右心室的代谢情况，我们对37例行择期冠状动脉搭桥手术并采用主动脉根部血液停搏液的患者进行了活检。在心脏停搏期间，右心室温度高于左心室温度（右心室：16.8摄氏度±3.8摄氏度，左心室：14.3摄氏度±3.7摄氏度，p = 0.02）。心脏停搏前，右心室三磷酸腺苷浓度低于左心室（右心室：13.8±7.8 mmol/kg，左心室：21.5±8.7 mmol/kg，p = 0.02）。再灌注后，右心室三磷酸腺苷浓度降至低水平（10±6 mmol/kg）。术后左、右心室高能磷酸浓度（三磷酸腺苷和磷酸肌酸水平之和）与心脏停搏期间的心肌温度呈负相关（r = -0.29，p = 0.048）。主动脉根部停搏液对右心室的降温效果不如对左心室的降温效果。术前较低的高能磷酸浓度可能增加了右心室对缺血性损伤的易感性。替代的心肌保护方法可能会改善右心室的降温与保护效果。
