Davies R A, Laks H, Wackers F J, Berger H J, Williams B, Hammond G L, Geha A S, Gottschalk A, Zaret B L
Ann Thorac Surg. 1982 Feb;33(2):123-31. doi: 10.1016/s0003-4975(10)61896-6.
Twenty-three surviving patients who were weaned from cardiopulmonary bypass with intraaortic balloon pump assistance returned for follow-up radionuclide left ventricular (LV) function and thallium 201 perfusion studies at a mean of 23 +/- 3 months following operation. It was found tat despite profound intraoperative myocardial depression requiring intraaortic balloon assistance, 13 patients had no change (within 10%) in the resting LV ejection fraction compared with the preoperative measurement. Among all 23 patients, there was no difference between mean (+/- standard error of the mean) preoperative and postoperative resting LV ejection fraction (48 +/- 4 vs 46 +/- 4%, p = not significant [NS]). Only 11 patients had perioperative myocardial infarction documented by new Q waves in the electrocardiogram, by elevation of creatine kinase-MB fraction, or by defects on thallium 201 imaging not explained by documented myocardial infarction before operation. Overall, postoperative resting LV ejection fraction was not different from the preoperative value in patients with perioperative myocardial infarction (44 +/- 7 vs 47 +/- 5%, p = NS). Postoperative resting LV ejection fraction rose by greater than 10% compared with preoperative values in 4 patients (3 with aortic valve replacement), remained within the 10% limit in 9 patients, and fell by greater than 10% in 10 patients (7 with perioperative myocardial infarction). Only 4 out of 16 patients studied at follow-up with exercise radionuclide studies demonstrated a normal LV response to exercise (greater than 5% increase in LV ejection fraction). Thus, among survivors requiring intraaortic balloon pump assistance for weaning from cardiopulmonary bypass, LV performance at rest is frequently preserved. In addition, 11 of the 23 patients had evidence of perioperative myocardial infarction, indicating a component of reversible intraoperative LV dysfunction.
23名在主动脉内球囊泵辅助下脱离体外循环的存活患者在术后平均23±3个月返回进行放射性核素左心室（LV）功能和铊201灌注研究。结果发现，尽管术中存在严重的心肌抑制需要主动脉内球囊辅助，但13名患者静息左心室射血分数与术前测量值相比无变化（在10%以内）。在所有23名患者中，术前和术后静息左心室射血分数的平均值（±平均标准误差）无差异（48±4%对46±4%，p=无显著性差异[NS]）。只有11名患者通过心电图新出现的Q波、肌酸激酶-MB分数升高或铊201显像出现术前记录的心肌梗死无法解释的缺损而被记录为围手术期心肌梗死。总体而言，围手术期心肌梗死患者术后静息左心室射血分数与术前值无差异（44±7%对47±5%，p=NS）。4名患者（3名接受主动脉瓣置换）术后静息左心室射血分数较术前值升高超过10%，9名患者保持在10%以内，10名患者（7名围手术期心肌梗死患者）下降超过10%。在随访时进行运动放射性核素研究的16名患者中，只有4名表现出左心室对运动的正常反应（左心室射血分数增加超过5%）。因此，在需要主动脉内球囊泵辅助以脱离体外循环的存活者中，静息时左心室功能常得以保留。此外，23名患者中有11名有围手术期心肌梗死的证据，表明术中存在可逆性左心室功能障碍。
