Lazar H L, Rajaii A, Roberts A J
Department of Cardiothoracic Surgery, Boston University Medical Center, Mass.
J Thorac Cardiovasc Surg. 1988 Apr;95(4):637-42.
Recent experimental studies have shown that pressure-controlled intermittent coronary sinus occlusion effectively reduces both infarct size and myocardium at risk after coronary artery occlusion. This study was undertaken to determine whether this modality was equally effective in altering reperfusion damage after a period of ischemic arrest. Fourteen pigs were placed on cardiopulmonary bypass and subjected to 2 hours of ischemic arrest with multidose potassium crystalloid cardioplegia supplemented with topical and systemic hypothermia (28 degrees C). During arrest, the mid-left anterior descending artery was occluded with a snare, which was released immediately after aortic unclamping. In seven pigs, a 7F balloon-tipped catheter was positioned in the coronary sinus and pressure-controlled intermittent coronary sinus occlusion was performed for 60 minutes after aortic unclamping. Seven other pigs served as controls. Parameters measured included stroke work index, ejection fraction, and myocardial pH in the distribution of the distal left anterior descending artery. Pigs treated with pressure-controlled intermittent coronary sinus occlusion had a significantly higher myocardial pH (6.99 +/- 0.06 versus 6.67 +/- 0.05, p less than 0.01), ejection fraction (50% +/- 2% versus 33% +/- 6%, p less than 0.01), and stroke work index (0.87 +/- 0.07 versus 0.61 +/- 0.05 gm-m/kg, p less than 0.01) after 60 minutes of reperfusion compared with those of the group not treated in this way. We conclude that pressure-controlled intermittent coronary sinus occlusion effectively reverses reperfusion damage after periods of ischemic arrest.
近期的实验研究表明，压力控制下的间歇性冠状静脉窦闭塞可有效减小冠状动脉闭塞后的梗死面积和危险心肌。本研究旨在确定这种方式在改变缺血性停搏一段时间后的再灌注损伤方面是否同样有效。将14头猪置于体外循环下，采用多剂量钾晶体心脏停搏液并辅以局部和全身低温（28摄氏度），使其经历2小时的缺血性停搏。停搏期间，用圈套器阻断左前降支中段，在主动脉松开后立即松开。7头猪在主动脉松开后，将一根7F带气囊导管置于冠状静脉窦，并进行60分钟的压力控制下的间歇性冠状静脉窦闭塞。另外7头猪作为对照。测量的参数包括左前降支远端分布区域的每搏功指数、射血分数和心肌pH值。与未采用这种方式治疗的组相比，接受压力控制下的间歇性冠状静脉窦闭塞治疗的猪在再灌注60分钟后的心肌pH值显著更高（6.99±0.06对6.67±0.05，p<0.01）、射血分数（50%±2%对33%±6%，p<0.01）和每搏功指数（0.87±0.07对0.61±0.05克-米/千克，p<0.01）。我们得出结论，压力控制下的间歇性冠状静脉窦闭塞可有效逆转缺血性停搏后的再灌注损伤。
