Ilbawi M N, Idriss F S, Muster A J, DeLeon S Y, Berry T E, Duffy C E, Paul M H
J Thorac Cardiovasc Surg. 1986 Aug;92(2):231-7.
An experimental model was devised to evaluate the effects of elevated coronary sinus pressure on left ventricular performance. Thirteen mongrel dogs were used. The coronary sinus was cannulated and its entire blood flow diverted into a reservoir. The pressure in the coronary sinus was increased from 5 to 25 torr by elevating the drainage reservoir in a stepwise fashion. Cardiac index, coronary arteriovenous difference, rate of rise of left ventricular pressure, left ventricular systolic time intervals, and coronary blood flow were measured. When the coronary sinus pressure reached 15 torr, there was a significant decrease in cardiac index (3.60 +/- 0.5 to 2.70 +/- 0.6 L/min/m2, p less than 0.001), coronary blood flow (13.7 +/- 3.1 to 7.0 +/- 2.1 ml/min, p less than 0.001), rate of rise of left ventricular pressure (1,567 +/- 275 to 1,331 +/- 314, p less than 0.05), and an increase in coronary arteriovenous difference (62.8% +/- 9.3% to 70.5% +/- 5.4% saturation, p less than 0.03). These experimental results were correlated with postoperative catheterization findings in 24 patients with the Fontan procedure. Patients with a mean right atrial pressure less than 15 torr had a left ventricular ejection fraction of 93% +/- 6% of predicted, whereas patients with a right atrial pressure of 15 torr or more had a left ventricular ejection fraction of 75% +/- 13% of predicted (p less than 0.001). These experimental and clinical data strongly suggest that elevated coronary sinus pressure has deleterious effects on ventricular function after the Fontan procedure. Modifications of the procedure, such as using the rudimentary right ventricle when feasible or diverting coronary sinus flow to the pulmonary venous atrium, might decrease coronary sinus hypertension and improve long-term results.
设计了一种实验模型来评估冠状静脉窦压力升高对左心室功能的影响。使用了13只杂种狗。将冠状静脉窦插管，并将其全部血流引流至一个储液器中。通过逐步升高引流储液器，使冠状静脉窦压力从5托增加到25托。测量了心脏指数、冠状动脉动静脉差值、左心室压力上升速率、左心室收缩时间间期和冠状动脉血流量。当冠状静脉窦压力达到15托时，心脏指数显著下降（从3.60±0.5降至2.70±0.6升/分钟/平方米，p<0.001），冠状动脉血流量下降（从13.7±3.1降至7.0±2.1毫升/分钟，p<0.001），左心室压力上升速率下降（从1567±275降至1331±314，p<0.05），冠状动脉动静脉差值增加（饱和度从62.8%±9.3%增至70.5%±5.4%，p<0.03）。这些实验结果与24例行Fontan手术患者的术后导管检查结果相关。平均右心房压力低于15托的患者，左心室射血分数为预测值的93%±6%，而右心房压力为15托或更高的患者，左心室射血分数为预测值的75%±13%（p<0.001）。这些实验和临床数据强烈表明，冠状静脉窦压力升高对Fontan手术后的心室功能有有害影响。对该手术进行改进，如在可行时使用残留的右心室或将冠状静脉窦血流引流至肺静脉心房，可能会降低冠状静脉窦高压并改善长期效果。
