Christakis G T, Fremes S E, Weisel R D, Ivanov J, Madonik M M, Seawright S J, McLaughlin P R
J Thorac Cardiovasc Surg. 1985 Aug;90(2):243-50.
Right coronary artery stenoses limit cardioplegic delivery to the right ventricle and may contribute to postoperative right ventricular dysfunction. Right ventricular function was evaluated in 39 patients with right coronary artery stenoses following elective coronary bypass operations. Hemodynamic and nuclear ventriculographic measurements, made between 3 and 6 hours postoperatively, revealed a progressive increase in pulmonary arterial pressure, pulse rate, and right ventricular ejection fraction (p less than 0.05). Right ventricular end-diastolic volume index (calculated from the thermodilution stroke index divided by the nuclear ejection fraction) decreased, but right atrial pressure increased (suggesting a decrease in compliance). The response to the infusion of 2 units of plasma (volume loading) was evaluated 3 hours postoperatively (EARLY) and again 5 hours postoperatively (LATE) in 21 patients. Right ventricular performance (the relation between cardiac index or right ventricular stroke work index and right ventricular end-diastolic volume index) and right ventricular systolic function (the relation between systolic pulmonary arterial pressure and right ventricular end-systolic volume index) were depressed EARLY and improved LATE (p less than 0.01 in analysis of covariance). Left ventricular performance (the relation between cardiac index or left ventricular stroke work index and left ventricular end-diastolic volume index) and left ventricular systolic function (the relation between systolic blood pressure and left ventricular end-systolic volume index) were similar EARLY and LATE. Right ventricular diastolic function (the relation between right atrial pressure and right ventricular end-diastolic volume index) and left ventricular diastolic function (the relation between left atrial pressure and left ventricular end-diastolic volume index) were significantly greater LATE than EARLY. Right, but not left, ventricular performance and systolic function were transiently depressed, and right and left ventricular diastolic stiffness were transiently decreased in the EARLY postoperative period. In patients with right coronary artery stenoses, current methods of cardioplegia may inadequately protect the right ventricle, but further studies are required to establish the relation between intraoperative protection and postoperative function.
右冠状动脉狭窄会限制心脏停搏液输送至右心室，可能导致术后右心室功能障碍。对39例择期冠状动脉搭桥术后出现右冠状动脉狭窄的患者进行了右心室功能评估。术后3至6小时进行的血流动力学和核心室造影测量显示，肺动脉压、脉搏率和右心室射血分数呈逐渐上升趋势（p<0.05）。右心室舒张末期容积指数（由热稀释心搏量指数除以核射血分数计算得出）下降，但右心房压力升高（提示顺应性降低）。在21例患者术后3小时（早期）和术后5小时（晚期）分别评估了输注2单位血浆（容量负荷）后的反应。右心室功能（心脏指数或右心室每搏功指数与右心室舒张末期容积指数之间的关系）和右心室收缩功能（收缩期肺动脉压与右心室收缩末期容积指数之间的关系）在早期受到抑制，晚期得到改善（协方差分析中p<0.01）。左心室功能（心脏指数或左心室每搏功指数与左心室舒张末期容积指数之间的关系）和左心室收缩功能（收缩压与左心室收缩末期容积指数之间的关系）在早期和晚期相似。右心室舒张功能（右心房压力与右心室舒张末期容积指数之间的关系）和左心室舒张功能（左心房压力与左心室舒张末期容积指数之间的关系）在晚期明显高于早期。在术后早期，右心室（而非左心室）功能和收缩功能短暂受到抑制，右心室和左心室舒张硬度短暂降低。对于右冠状动脉狭窄的患者，目前的心脏停搏方法可能无法充分保护右心室，但需要进一步研究以确定术中保护与术后功能之间的关系。
