Pennington D G, Dincer B, Bashiti H, Barner H B, Kaiser G C, Tyras D H, Codd J E, Willman V L
Ann Thorac Surg. 1982 Jun;33(6):576-84. doi: 10.1016/s0003-4975(10)60816-8.
From July, 1977, to July, 1980, intermittent cold blood potassium cardioplegia was used in 208 patients undergoing aortic valve replacement. Aortic root injection of the cardioplegic solution at 10 degrees C was followed every 20 to 30 minutes by infusions of the solution through Silastic cannulas sutured in the coronary orifices or reinserted with each injection. Symptoms of myocardial ischemia developed in 6 patients 3 to 30 months postoperatively. Coronary angiography confirmed new stenoses of the left orifice (3 patients), left main trunk (1 patient), left anterior descending coronary artery (2 patients), circumflex coronary artery (1 patients), and right orifice (3 patients). Four patients underwent saphenous vein grafting procedures, with 2 deaths; 2 patients refused reoperation. A seventh patient with 80% stenosis of the circumflex coronary artery and a posterolateral myocardial infarction died 2 months after double-valve replacement. Intermittent cold blood potassium cardioplegia instead of continuous perfusion did not prevent coronary arterial injury. Injuries occurred in the distal coronary arteries as well as the orifices and were not prevented by withdrawal of the cannulas between injections. Tight-fitting cannulas and high-pressure injection should be avoided. A careful search for coronary arterial injury should be made in all symptomatic patients following aortic valve replacement.
1977年7月至1980年7月，208例接受主动脉瓣置换术的患者使用了间断冷血钾停搏液。在10℃时经主动脉根部注射停搏液，随后每隔20至30分钟通过缝合在冠状动脉口或每次注射时重新插入的硅橡胶套管输注该溶液。6例患者在术后3至30个月出现心肌缺血症状。冠状动脉造影证实左冠状动脉口（3例）、左主干（1例）、左前降支冠状动脉（2例）、回旋支冠状动脉（1例）和右冠状动脉口（3例）出现新的狭窄。4例患者接受了大隐静脉移植手术，2例死亡；2例患者拒绝再次手术。第7例患者在双瓣置换术后2个月死亡，其回旋支冠状动脉狭窄80%并伴有后外侧心肌梗死。间断冷血钾停搏液而非持续灌注并不能预防冠状动脉损伤。损伤发生在冠状动脉远端以及冠状动脉口，且注射期间拔出套管并不能预防损伤。应避免使用紧配合的套管和高压注射。对于所有主动脉瓣置换术后出现症状的患者，应仔细检查是否存在冠状动脉损伤。
