Maurer G, Punzengruber C, Haendchen R V, Torres M A, Heublein B, Meerbaum S, Corday E
J Am Coll Cardiol. 1984 Sep;4(3):577-86. doi: 10.1016/s0735-1097(84)80105-9.
Coronary venous injections of sonicated Renografin-76 were performed in seven closed chest dogs during two-dimensional echocardiography to study the ability of this new technique to opacify regional myocardium before and after occlusion of the left anterior descending coronary artery. The balloon of a 4F double lumen catheter was inflated in the great cardiac vein for each contrast injection to prevent backflow through the coronary sinus into the right atrium. Retrograde injections before coronary artery occlusion generally resulted in patchy myocardial contrast uptake. Injections after coronary occlusion always resulted in confluent and transmural myocardial opacification which occupied 42.8 +/- 8.6% (range 26 to 54) (mean +/- standard deviation) of the myocardial circumference. Retrograde opacification always extended into adjacent myocardium beyond the ischemic zone, which was assessed in echocardiograms with antegrade contrast injections into the left main coronary artery and which measured 30 +/- 6.3% of the ventricular circumference. Shunting from the coronary venous system to cardiac chambers was evaluated in a parasternal four chamber view and was graded on a scale of 0 to 4+. Contrast appearance was equally intense in the right atrium and right ventricle (3.5 +/- 0.6+, range 2+ to 4+), less intense in the left ventricular cavity (1.5 +/- 0.6+, range 1+ to 3+) and absent in the left atrium. Postmortem anatomic validation with retrograde great cardiac vein injections of indocyanine green corroborated and in vivo contrast appearance in chambers. Retrograde coronary venous contrast echocardiography appears capable of providing in vivo information about the extent and location of myocardial zones that can be reached by retrograde infusions of therapeutic agents and about the ability of these agents to reach ischemic myocardium. In addition, this new method allows for in vivo evaluation of shunts between coronary veins and cardiac chambers, which may influence the efficacy of retrograde interventions.
在七只开胸犬二维超声心动图检查期间，经冠状静脉注射超声处理的泛影葡胺-76，以研究这项新技术在左前降支冠状动脉闭塞前后使局部心肌显影的能力。每次注射造影剂时，将4F双腔导管的球囊在冠状大静脉中充盈，以防止造影剂通过冠状窦回流到右心房。冠状动脉闭塞前的逆行注射通常导致心肌造影剂摄取呈斑片状。冠状动脉闭塞后的注射总是导致心肌显影融合且透壁，占心肌周长的42.8±8.6%（范围26%至54%）（平均值±标准差）。逆行显影总是延伸至缺血区以外的相邻心肌，缺血区通过向左冠状动脉主干顺行注射造影剂在超声心动图中评估，占心室周长的30±6.3%。在胸骨旁四腔视图中评估从冠状静脉系统到心腔的分流情况，并按0至4+进行分级。右心房和右心室中的造影剂显影强度相同（3.5±0.6+，范围2+至4+），左心室腔中较弱（1.5±0.6+，范围1+至3+），左心房中无造影剂显影。用逆行冠状大静脉注射吲哚菁绿进行的尸检解剖验证证实了心腔内的体内造影剂显影情况。逆行冠状静脉造影超声心动图似乎能够提供关于通过逆行输注治疗药物可到达的心肌区域的范围和位置以及这些药物到达缺血心肌能力的体内信息。此外，这种新方法允许对冠状静脉和心腔之间的分流进行体内评估，这可能会影响逆行干预的疗效。
