Olin C, Bomfim V
Scand J Thorac Cardiovasc Surg. 1979;13(3):221-5. doi: 10.3109/14017437909100555.
A simple method for hypothermic cardioplegia during aortic valve surgery is described. Cold cardioplegic solution (Ringer's acetate with 16 mEq potassium added) was selectively infused into the left coronary artery after the aorta had been opened. This resulted in an even cooling of the left ventricle with a relatively small amount of cardioplegic solution. Local cooling with "soft ice" was then initiated and the heart isolated from its warmer surroundings with the aid of a specially designed pad of compressed plastic foam. Thus, the left ventricular temperature could be kept below 20 degrees C for more than one hour. One hundred and three (103) patients were operated on with this method during a one-year-period. Only one patient died (1%). There were few early and/or late complications. Postoperative heart function was excellent in 23 patients subjected to a special study. Peak aortic pressure during the first 16 postoperative hours was 130 (+/- 22) mmHg, mean left atrial pressure 12 (+/- 2) mmHg, mean right atrial pressure 10 (+/- 2) mmHg and all patients were in sinus rhythm. There was a brief and limited release of myocardial enzymes postoperatively, indicating slight intra-operative myocardial damage. Apart from the cardioplegic technique, there are certain factors of importance for the efficacy of myocardial protection during aortic valve replacement. Among them may be mentioned avoidance of ventricular fibrillation, gentle reperfusion after release of the aortic cross-clamping, avoidance of left ventricular distension and administration of calcium intravenously before termination of bypass.
本文描述了一种在主动脉瓣手术中进行低温心脏停搏的简单方法。在打开主动脉后，将冷心脏停搏液（添加了16 mEq钾的醋酸林格液）选择性地注入左冠状动脉。这使得左心室能够用相对少量的心脏停搏液均匀降温。然后开始用“软冰”进行局部降温，并借助特制的压缩塑料泡沫垫将心脏与较温暖的周围环境隔离开来。这样，左心室温度可保持在20摄氏度以下达一个多小时。在一年期间，有103例患者采用这种方法进行了手术。仅1例患者死亡（1%）。早期和/或晚期并发症很少。在23例接受特殊研究的患者中，术后心脏功能良好。术后最初16小时内的主动脉峰值压力为130（±22）mmHg，平均左心房压力为12（±2）mmHg，平均右心房压力为10（±2）mmHg，所有患者均为窦性心律。术后心肌酶有短暂且有限的释放，表明术中存在轻微的心肌损伤。除了心脏停搏技术外，在主动脉瓣置换术中，还有某些因素对心肌保护的效果至关重要。其中包括避免心室颤动、主动脉阻断解除后的轻柔再灌注、避免左心室扩张以及在体外循环结束前静脉注射钙剂。
