Salter D R, Goldstein J P, Abd-Elfattah A, Murphy C E, Brunsting L A, Wechsler A S
Department of Surgery, Duke University Medical Center, Durham, NC 27710.
Circulation. 1987 Nov;76(5 Pt 2):V129-40.
Continuous retrograde coronary sinus cardioplegia (CSCP) has previously been carefully evaluated experimentally and shown to be efficacious during ischemia, even in the presence of coronary lesions and in the hypertrophied state. A new technique of retrograde cardioplegia delivery through the right atrium, using right ventricular distension and pressures of 60 mm Hg, has recently been described with excellent clinical results. This study was designed to specifically examine right ventricular function after atrial cardioplegia and acute passive right ventricular distension. CSCP (n = 10) was compared with cardioplegia delivered through the right atrium both continuously (n = 10) and intermittently (n = 8). When ventricular function was examined with the use of the load-independent relationship of stroke work vs end-diastolic length, there was a profound deterioration of right ventricular function in both atrial cardioplegia groups (44% and 37% of control values, respectively) after 1 hr of reperfusion. In contrast, biventricular function was fully preserved in the CSCP group 1 hr after reperfusion. Left ventricular function measured at the end of reperfusion was preserved in all three groups. Right ventricular ATP levels were slightly but significantly depressed in all groups and in the atrial cardioplegia groups, this metabolic change was also seen in the left ventricle. These metabolic and hemodynamic data may reflect the inability of atrial cardioplegia to cool the myocardium below 16 degrees C. Postoperative right ventricular dysfunction may be more common than has been previously thought when atrial cardioplegia is used, particularly in the absence of topical cooling.
持续逆行冠状静脉窦心肌停搏（CSCP）此前已在实验中得到仔细评估，并显示在缺血期间有效，即使存在冠状动脉病变和心肌肥厚状态时也是如此。最近描述了一种通过右心房进行逆行心肌停搏的新技术，利用右心室扩张和60毫米汞柱的压力，临床效果极佳。本研究旨在专门检查心房心肌停搏和急性被动右心室扩张后的右心室功能。将CSCP组（n = 10）与持续（n = 10）和间歇（n = 8）通过右心房给予心肌停搏的组进行比较。当使用每搏功与舒张末期长度的负荷无关关系来检查心室功能时，在再灌注1小时后，两个心房心肌停搏组的右心室功能均有显著恶化（分别为对照值的44%和37%）。相比之下，CSCP组在再灌注1小时后双心室功能完全得以保留。再灌注结束时测量的左心室功能在所有三组中均得以保留。所有组的右心室ATP水平均略有但显著降低，在心房心肌停搏组中，左心室也出现了这种代谢变化。这些代谢和血流动力学数据可能反映了心房心肌停搏无法将心肌温度降至16摄氏度以下。当使用心房心肌停搏时，术后右心室功能障碍可能比以前认为的更为常见，尤其是在没有局部降温的情况下。
