Lazar H L, Khoury T, Rivers S
Department of Cardiothoracic Surgery, Boston University Medical Center, MA 02118.
Ann Thorac Surg. 1988 Aug;46(2):202-7. doi: 10.1016/s0003-4975(10)65898-5.
Coronary occlusions may alter the distribution of antegrade cardioplegia and result in ischemic damage. This study was undertaken to determine whether pressure-controlled intermittent coronary sinus occlusion (PICSO) could improve antegrade cardioplegic delivery when coronary occlusions are present. Twenty pigs were subjected to 120 minutes of ischemic arrest with antegrade, multidose, potassium crystalloid cardioplegia. During arrest, the mid-left anterior descending artery was occluded with a snare, which was released on reperfusion. In 10 pigs, a balloon-tipped catheter was placed in the coronary sinus and PICSO was performed during each cardioplegia dose. PICSO-treated hearts had faster arrests (27 +/- 5 versus 102 +/- 21 [SE] seconds; p less than 0.02), as well as lower temperatures (18.4 +/- 1.0 versus 22.0 +/- 1.4 degrees C; p less than 0.05) and higher tissue pH (6.58 +/- 0.09 versus 6.31 +/- 0.09; p less than 0.05) just before aortic unclamping. Postischemic end-diastolic volume was unchanged with PICSO, but it decreased in non-PICSO-treated hearts. PICSO-treated hearts generated a higher postischemic stroke work index (0.70 +/- 0.08 versus 0.38 +/- 0.08 g-m/kg; end-diastolic volume, 60 ml; p less than 0.05). We conclude that PICSO improves cardioplegic distribution, thus reducing ischemic injury.
冠状动脉闭塞可能会改变顺行性心脏停搏液的分布并导致缺血性损伤。本研究旨在确定当存在冠状动脉闭塞时，压力控制间歇性冠状动脉窦闭塞（PICSO）是否能改善顺行性心脏停搏液的输送。20只猪接受了120分钟的缺血性停搏，采用顺行性、多剂量、钾晶体心脏停搏液。在停搏期间，用圈套器闭塞左前降支中段，再灌注时松开。在10只猪中，将球囊导管置于冠状窦，并在每次给予心脏停搏液时进行PICSO。接受PICSO治疗的心脏停搏更快（27±5秒对102±21[SE]秒；p<0.02），在即将松开主动脉阻断钳时温度更低（18.4±1.0℃对22.0±1.4℃；p<0.05），组织pH值更高（6.58±0.09对6.31±0.09；p<0.05）。缺血后舒张末期容积在PICSO组无变化，但在未接受PICSO治疗的心脏中减小。接受PICSO治疗的心脏产生更高的缺血后每搏作功指数（0.70±0.08对0.38±0.08g-m/kg；舒张末期容积，60ml；p<0.05）。我们得出结论，PICSO改善了心脏停搏液的分布，从而减少了缺血性损伤。
