Peniston C M, Spence P A, Mihic N, Jabr A K, McLennan M, Yap V, Salerno T A
Ann Thorac Surg. 1986 May;41(5):473-7. doi: 10.1016/s0003-4975(10)63020-2.
Atrial electrical and mechanical activity persists during cardioplegic arrest. It has been postulated that atrial ischemia may occur and cause deterioration in atrial function. This study was designed to assess the effect of cardioplegic arrest on right atrial function. Twenty-one pigs were placed on cardiopulmonary bypass (CPB), and the right atrium was isolated from the circulation by snaring both venae cavae and incising the coronary sinus. The tricuspid valve was closed through a small right ventriculotomy, and baseline atrial function was assessed using a compliant balloon in the atrium. Fourteen pigs underwent one hour of cardioplegic arrest (7 with cardioplegia alone [CCA group] and 7 with the addition of topical hypothermia [CCA + TH group]) followed by one hour of normothermic reperfusion. Seven other pigs were placed on CPB for the same period of time (CPB group). Atrial electrical and mechanical activity persisted at 45 beats per minute in the CCA group but was virtually abolished in the CCA + TH group. Cardioplegic arrest caused considerable deterioration in right atrial function (developed pressure, 18.9 +/- 0.8 [baseline] versus 14.1 +/- 0.7 mm Hg; p less than 0.05; first derivative of atrial pressure [dP/dt], 187 +/- 19 versus 134 +/- 25 mm Hg per second; p less than 0.05; 60 minutes of reperfusion and balloon volume of 20 ml). It was not affected by topical cooling. Right atrial developed pressure was maintained, but dP/dt was significantly reduced in the CPB group. This study suggests that cardioplegic arrest does not protect the atrium.
心脏停搏期间心房电活动和机械活动持续存在。据推测，可能会发生心房缺血并导致心房功能恶化。本研究旨在评估心脏停搏对右心房功能的影响。将21头猪置于体外循环（CPB）下，通过圈套上下腔静脉并切开冠状窦，使右心房与循环隔离。通过小的右心室切口关闭三尖瓣，并使用心房内顺应性球囊评估基线心房功能。14头猪经历1小时心脏停搏（7头仅用心脏停搏液[CCA组]，7头加用局部低温[CCA + TH组]），随后进行1小时常温再灌注。另外7头猪在相同时间段内置于CPB下（CPB组）。CCA组心房电活动和机械活动以每分钟45次搏动持续存在，但在CCA + TH组中几乎完全消失。心脏停搏导致右心房功能显著恶化（舒张末压力，18.9±0.8[基线]对14.1±0.7 mmHg；p<0.05；心房压力一阶导数[dP/dt]，187±19对134±25 mmHg每秒；p<0.05；再灌注60分钟且球囊容积为20 ml）。它不受局部降温影响。CPB组右心房舒张末压力得以维持，但dP/dt显著降低。本研究表明心脏停搏并不能保护心房。
