Rudis E, Gates R N, Laks H, Drinkwater D C, Ardehali A, Aharon A, Chang P
Department of Surgery, University of California, Los Angeles Medical Center 90024, USA.
J Thorac Cardiovasc Surg. 1995 May;109(5):941-6; discussion 946-7. doi: 10.1016/S0022-5223(95)70320-9.
This study documents the gross flow characteristics and capillary distribution of cardioplegic solution delivered retrogradely with the coronary sinus open versus closed.
Five explanted human hearts from transplant recipients were used as experimental models. Hearts served as their own controls and received two doses of warm blood cardioplegic solution, each containing colored microspheres. The first dose was delivered through a retroperfusion catheter with the coronary sinus open and the second dose was delivered with the sinus occluded. Capillary flow was measured at twelve ventricular sites and gross flow was measured by examining coronary sinus regurgitation, thebesian vein drainage, and aortic effluent (nutrient flow).
Coronary sinus ostial occlusion allowed for a significant decrease in total cardioplegic flow (1.74 +/- 0.40 ml/gm versus 1.06 +/- 0.32 ml/gm; p < 0.05) to occur while maintaining an identical intracoronary sinus pressure. Ostial occlusion also resulted in an increase in the ratio of nutrient flow/total cardioplegic flow from 32.3% +/- 15.1% to 61.3% +/- 7.9% (p < 0.05). A statistically significant improvement in capillary flow was found at the midventricular level in the posterior intraventricular septum and posterolateral right ventricular free wall. This improvement was also documented for the intraventricular septum and right ventricle at the level of the apex.
Coronary sinus occlusion during retrograde cardioplegia significantly improves cardioplegic delivery to the right ventricle and posterior intraventricular septum. Furthermore, the technique affords a significant improvement in nutrient cardioplegic flow while reducing the overall volume of cardioplegic solution administered.
本研究记录了在冠状窦开放与封闭状态下逆行灌注心脏停搏液的总体流动特征和毛细血管分布情况。
使用来自移植受者的5颗离体人心脏作为实验模型。心脏自身作为对照，接受两剂温血心脏停搏液，每剂均含有彩色微球。第一剂通过逆行灌注导管在冠状窦开放时注入，第二剂在冠状窦闭塞时注入。在12个心室部位测量毛细血管血流，并通过检查冠状窦反流、心最小静脉引流和主动脉流出液（营养血流）来测量总体血流。
冠状窦口闭塞在保持冠状窦内压力相同的情况下，使心脏停搏液的总流量显著降低（1.74±0.40毫升/克对1.06±0.32毫升/克；p<0.05）。口部闭塞还导致营养血流/心脏停搏液总流量的比率从32.3%±15.1%增加到61.3%±7.9%（p<0.05）。在室间隔后部和右心室后外侧游离壁的心室中部水平发现毛细血管血流有统计学意义的改善。在心室尖部水平的室间隔和右心室也记录到了这种改善。
逆行心脏停搏期间冠状窦闭塞可显著改善心脏停搏液向右心室和室间隔后部的输送。此外，该技术在减少心脏停搏液总体积的同时，使营养性心脏停搏液血流有显著改善。
