Chesebro J H, Ritman E L, Frye R L, Smith H C, Vlietstra R E, Pluth J R
Circulation. 1982 Jun;65(7 Pt 2):98-105. doi: 10.1161/01.cir.65.7.98.
Left ventricular performance was studied before and late (mean 12-17 months) after aortocoronary artery bypass surgery by quantitative, computer-based videoangiography. We measured total function (left ventricular ejection fraction, volumes and end-diastolic pressure) at rest (in 60 patients) and before and after exercise (abnormal exercise hemodynamics preoperatively in 32 patients) and regional function (peak rate of systolic wall thickening) at rest (in 60 patients) and before and after administration of nitroglycerin (in 19 patients). Total left ventricular function at rest is usually unchanged postoperatively. Exercise hemodynamics are more sensitive indexes of performance and, if abnormal, usually improve postoperatively if revascularization has been complete and extensive myocardial infarction has not occurred. Regional myocardial function usually improves postoperatively if the bypass graft to the region is patent and has a blood flow of more than 60 ml/min (measured late postoperatively by videodensitometry) and if no previous infarction was present in the region. Myocardial infarction and graft blood flow of 40 ml/min or less are the two main factors that prevent improvement in abnormal regions defined by the regional wall thickening method when bypass grafts are patent. Regions supplied by occluded grafts show decreases in regional function. The preoperative wall-thickening response to administration of nitroglycerin can be used to distinguish ischemia and significant myocardial infarction and to predict the successful response to aortocoronary bypass graft surgery.
采用基于计算机的定量视频血管造影术，对60例患者在主动脉冠状动脉搭桥手术前后（平均12 - 17个月）的左心室功能进行了研究。我们测量了静息状态下（60例患者）、运动前后（32例术前运动血流动力学异常的患者）的整体功能（左心室射血分数、容积和舒张末期压力），以及静息状态下（60例患者）和使用硝酸甘油前后（19例患者）的局部功能（收缩期室壁增厚峰值速率）。术后静息状态下左心室整体功能通常无变化。运动血流动力学是更敏感的功能指标，如果异常，若血运重建完全且未发生大面积心肌梗死，术后通常会改善。如果该区域的搭桥血管通畅且血流量超过60 ml/min（术后晚期通过视频密度测定法测量），并且该区域既往无梗死，则局部心肌功能术后通常会改善。心肌梗死和搭桥血管血流量在40 ml/min及以下是当搭桥血管通畅时，阻止区域壁增厚法所定义的异常区域功能改善的两个主要因素。由闭塞的搭桥血管供血的区域，局部功能会降低。术前使用硝酸甘油后的室壁增厚反应可用于区分缺血和严重心肌梗死，并预测主动脉冠状动脉搭桥手术的成功反应。
