Gates R N, Laks H, Drinkwater D C, Pearl J M, Zaragoza A M, Lewis W, Sorensen T J, Kaczer E M, Chang P A
Department of Surgery, University of California, Los Angeles, Medical Center 90024.
Ann Thorac Surg. 1993 Sep;56(3):410-6; discussion 417. doi: 10.1016/0003-4975(93)90872-f.
In this report, explanted hearts from transplant recipients with the diagnosis of idiopathic cardiomyopathy underwent a blood cardioplegia arrest and extended subatrial resection to preserve their coronary sinus venous system. The coronary sinus and left and right coronary arteries were then cannulated and warm blood cardioplegia retrograde infused at a pressure of 30 to 40 mm Hg. Effluent from the coronary arteries and thebesian veins was then collected. Hearts were subsequently fixed with retrograde glutaraldehyde perfusion and perfused retrograde with NTB-2 (an inert intracapillary marker). Histologic sections were examined from 12 separate sites. There was no significant difference in the percentage of capillaries perfused by retrograde-delivered cardioplegia between corresponding regions of the left and right ventricles. However, effluent analysis indicated that 67.2% +/- 6.4% of retrograde-delivered blood cardioplegia was shunted through thebesian veins, thereby bypassing the microvasculature, whereas 29.3% +/- 6.3% and 3.5% +/- 3.1% traversed the myocardium supplied by the left and right coronary arteries, respectively. The results indicate that all regions of both ventricles are perfused by retrograde blood cardioplegia. However, they also suggest that nutrient flow to the microvasculature of the right ventricle is minimal during retrograde cardioplegia.
在本报告中，对诊断为特发性心肌病的移植受者的离体心脏进行冷血心脏停搏，并进行广泛的房间隔下切除以保留其冠状静脉窦系统。然后将冠状静脉窦以及左、右冠状动脉插管，并以30至40毫米汞柱的压力逆行灌注温血心脏停搏液。随后收集冠状动脉和心最小静脉的流出液。心脏随后用逆行戊二醛灌注固定，并用NTB - 2（一种惰性毛细管标记物）逆行灌注。从12个不同部位检查组织切片。左、右心室相应区域通过逆行给予的心脏停搏液灌注的毛细血管百分比无显著差异。然而，流出液分析表明，逆行给予的冷血心脏停搏液中有67.2%±6.4%通过心最小静脉分流，从而绕过了微血管系统，而分别有29.3%±6.3%和3.5%±3.1%穿过左、右冠状动脉供血的心肌。结果表明，两个心室的所有区域均由逆行冷血心脏停搏液灌注。然而，它们也表明在逆行心脏停搏期间，右心室微血管的营养血流极少。
