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[左心转流对正常及急性心力衰竭犬右心室功能的影响——电导导管在右心室的应用]

[Effect of left heart bypass on right ventricular function in normal and acute heart failure dogs--an application of the conductance catheter to the right ventricle].

作者信息

Kitano M, Hee P C, Nishimura K, Okamoto Y, Ban T

机构信息

Department of Cardiovascular Surgery, Kyoto University Faculty of Medicine, Japan.

出版信息

Nihon Kyobu Geka Gakkai Zasshi. 1994 Sep;42(9):1320-9.

PMID:7989791
Abstract

We investigated right ventricular function during left heart bypass (LHB) with 18 mongrel open-chest dogs, in normal and acute heart failure (AHF) dogs which underwent aortic cross clamp. Left ventricular unloading was completely accomplished with a centrifugal pump. For more accurate evaluation of right ventricular volume, conductance catheter was employed to assess right ventricular function. Analysis were performed with right ventricular pressure-volume curve which was changed by transient volume loading on right ventricle. And right ventricular properties with and without LHB were compared by the use of load independent parameters as follows. Right ventricular systolic property was evaluated by maximum elastance (Emax) and stroke work-end-diastolic volume relation (SW/EDVR), and its diastolic function was evaluated by end-diastolic pressure-volume relation (EDP/VR). Overall right ventricular performance was assessed by stroke work-end-diastolic pressure relationship (SW/EDPR). In the normal heart, only a parallel shift to the right in EDP/VR and SW/EDVR was noted without any significant changes in slope with LHB. On the other hand, in AHF dogs, the slope of SW/EDVR and SW/EDPR were increased from 0.14 +/- 0.08 to 0.18 +/- 0.08 (p < 0.05), from 0.22 +/- 0.15 to 0.34 +/- 0.19 (p < 0.01), respectively, and the curve of EDP/VR was shifted right and downward. These result suggested that decompression of the left ventricle and septal shifting by LHB provided good diastolic compliance and afterload unloading of the right ventricle, and these effects had a more significant role in acute heart failure than in the normal heart.

摘要

我们用18只杂种开胸犬研究了在左心转流(LHB)期间的右心室功能,这些犬处于正常状态以及经历了主动脉交叉钳夹的急性心力衰竭(AHF)状态。用离心泵完全实现左心室卸载。为了更准确地评估右心室容积,采用电导导管来评估右心室功能。通过右心室压力-容积曲线进行分析,该曲线因右心室的短暂容量负荷而改变。并且通过使用如下负荷独立参数比较有和没有LHB时的右心室特性。通过最大弹性(Emax)和每搏功-舒张末期容积关系(SW/EDVR)评估右心室收缩特性,通过舒张末期压力-容积关系(EDP/VR)评估其舒张功能。通过每搏功-舒张末期压力关系(SW/EDPR)评估右心室整体性能。在正常心脏中,LHB时仅观察到EDP/VR和SW/EDVR向右平行移位,斜率无任何显著变化。另一方面,在AHF犬中,SW/EDVR和SW/EDPR的斜率分别从0.14±0.08增加到0.18±0.08(p<0.05),从0.22±0.15增加到0.34±0.19(p<0.01),并且EDP/VR曲线向右下方移位。这些结果表明,LHB导致的左心室减压和室间隔移位为右心室提供了良好的舒张顺应性和后负荷卸载,并且这些作用在急性心力衰竭中比在正常心脏中发挥更显著的作用。

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