Nishida H, Endo M, Koyanagi H, Grooters R K, Merkley D F
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
Cardiovasc Surg. 1995 Aug;3(4):375-80. doi: 10.1016/0967-2109(95)94154-o.
Surgical coronary artery fistula, in which the last anastomosis is created to a low-pressure cardiac chamber, was recently introduced as an alternative method to improve graft flow and patency in a sequential graft when coronary arteries are small or diffusely diseased. To assess graft flow, effect on haemodynamics, flow distribution and to determine proper size of the distal anastomosis, a saphenous vein was sequentially anastomosed from the ascending aorta to the left anterior descending artery and then to the left atrium in eight mongrel dogs. Graft flow was measured before and after opening the fistula to the left atrium between the ascending aorta and left anterior descending artery (flow A) and between the left anterior descending artery and left atrium (flow B). Left atrium pressure and systolic left ventricular pressure (mmHg) were recorded. The diameter of the distal anastomosis was regulated with a bulldog clamp. When distal anastomosis was at 2.5-3 mm mean(s.d.) flow A increased from 64.5(19.5) to 134.7(28.5) ml/min (P < 0.01) without significant left atrial pressure or left ventricular pressure change. With a distal anastomosis of 4 mm or more, flow A increased from 69.8(19.9) to 396.1(62.2) ml/min (P < 0.001). Left atrial pressure increased from 5.6(1.0) to 6.1(0.9) mmHg (P < 0.05) without a change in left ventricular pressure. In both sizes of distal anastomosis, flow to the left anterior descending artery did not change either before or after the shunt (flow B) was opened. Neither volume loading, rapid atrial pacing, neosynephrine or epinephrine infusions caused deleterious haemodynamic effects with the shunt open.(ABSTRACT TRUNCATED AT 250 WORDS)
外科冠状动脉瘘，即最后吻合至低压心腔，最近被引入作为一种替代方法，用于在冠状动脉细小或弥漫性病变时改善序贯移植血管的血流和通畅性。为了评估移植血管血流、对血流动力学的影响、血流分布并确定远端吻合口的合适尺寸，在8只杂种犬中，将大隐静脉依次从升主动脉吻合至左前降支动脉，然后再吻合至左心房。在升主动脉与左前降支动脉之间（血流A）以及左前降支动脉与左心房之间（血流B）开通至左心房的瘘管前后，测量移植血管血流。记录左心房压力和左心室收缩压（mmHg）。用动脉夹调节远端吻合口的直径。当远端吻合口直径为2.5 - 3 mm时，平均（标准差）血流A从64.5（19.5）ml/min增加至134.7（28.5）ml/min（P < 0.01），左心房压力或左心室压力无显著变化。当远端吻合口直径为4 mm或更大时，血流A从69.8（19.9）ml/min增加至396.1（62.2）ml/min（P < 0.001）。左心房压力从5.6（1.0）mmHg增加至6.1（0.9）mmHg（P < 0.05），左心室压力无变化。在两种尺寸的远端吻合口中，分流（血流B）开通前后，流向左前降支动脉的血流均无变化。在分流开放的情况下，容量负荷、快速心房起搏、去氧肾上腺素或肾上腺素输注均未引起有害的血流动力学效应。（摘要截断于250字）
