Miura T, Hiramatsu T, Forbess J M, Mayer J E
Department of Cardiovascular Surgery, Children's Hospital, Boston, Mass 02115, USA.
Circulation. 1995 Nov 1;92(9 Suppl):II298-303. doi: 10.1161/01.cir.92.9.298.
After the Fontan operation there is elevated systemic venous pressure, and the coronary sinus pressure (CSP) may also be elevated depending on the operative technique. Elevated CSP can potentially alter coronary perfusion and thereby be a cause for postoperative left ventricular (LV) dysfunction.
The effects of elevated CSP on coronary blood flow (CBF) and LV function were evaluated in 14 isolated blood-perfused juvenile lamb hearts. After baseline measurements were made, CSP was elevated by a 10-minute inflation of a balloon catheter inserted into the coronary sinus via the hemiazygos vein in 7 hearts (CSHT group) to cause moderate (phase I, approximately 15 mm Hg) and severe (phase II, approximately 30 mm Hg) elevations of mean CSP at a constant coronary perfusion pressure (80 mm Hg). The results were compared with results from 7 hearts continuously perfused without elevation of CSP (C group). Mean CSP in the CSHT group was elevated from 0.4 +/- 1.9 to 16.4 +/- 2.4 mm Hg during phase I and to 32.6 +/- 3.6 mm Hg during phase II. CBF in the CSHT group decreased to 89.7 +/- 5.2% in phase I and to 79.0 +/- 13.2% in phase II, and these values were significantly lower than those in the C group (98.5 +/- 6.7% in phase I and 106.8 +/- 16.0% in phase II; P < .05 each). There were no significant differences in maximum developed pressure (DP), max+dP/dt, max-dP/dt, or LV end-diastolic pressure (LVEDP) at a fixed volume between the CSHT group and the C group either in phase I or phase II. The time constant of pressure decline during LV isovolumic relaxation (tau) showed no significant difference in phase I, but in phase II tau was significantly higher in the CSHT group (116.2 +/- 7.8%) than that in the C group (106.3 +/- 8.5%; P < .05).
Elevated CSP on a short-term basis did not affect the LV systolic function indexes (max DP, max+dP/dt), max-dP/dt, or LVEDP at a fixed volume, but tau did appear to worsen and CBF decreased during CSP elevation. These actions might have deleterious effects on the LV over a longer time period.
在实施Fontan手术后，体循环静脉压升高，根据手术技术不同，冠状窦压力（CSP）也可能升高。升高的CSP可能会改变冠状动脉灌注，进而导致术后左心室（LV）功能障碍。
在14个离体血液灌注的幼年羔羊心脏中评估了升高的CSP对冠状动脉血流（CBF）和LV功能的影响。在进行基线测量后，7个心脏（CSHT组）通过经半奇静脉插入冠状窦的球囊导管充气10分钟来升高CSP，在恒定冠状动脉灌注压力（80 mmHg）下使平均CSP出现中度（I期，约15 mmHg）和重度（II期，约30 mmHg）升高。将结果与7个未升高CSP持续灌注的心脏（C组）的结果进行比较。CSHT组在I期平均CSP从0.4±1.9 mmHg升高至16.4±2.4 mmHg，在II期升高至32.6±3.6 mmHg。CSHT组的CBF在I期降至89.7±5.2%，在II期降至79.0±13.2%，这些值显著低于C组（I期为98.5±6.7%，II期为106.8±16.0%；每组P <.05）。在I期或II期，CSHT组和C组在固定容积下的最大舒张末压（DP）、最大 +dP/dt、最大 -dP/dt或左心室舒张末压（LVEDP）均无显著差异。左心室等容舒张期压力下降的时间常数（tau）在I期无显著差异，但在II期CSHT组的tau显著高于C组（116.2±7.8%比106.3±8.5%；P <.05）。
短期内升高的CSP在固定容积下不影响LV收缩功能指标（最大DP、最大 +dP/dt）、最大 -dP/dt或LVEDP，但在CSP升高期间tau似乎恶化且CBF降低。这些作用在更长时间内可能对LV产生有害影响。
