Aronson S, Lee B K, Zaroff J G, Wiencek J G, Walker R, Feinstein S, Karp R B
Department of Anesthesia and Critical Care, University of Chicago, IL 60637.
J Thorac Cardiovasc Surg. 1993 Feb;105(2):214-21.
The myocardial distribution of both antegrade and retrograde cardioplegia for cardiac surgical intervention, after induction of cardioplegia via the aortic root, was directly assessed and compared in 19 patients by means of contrast echocardiography. Two-dimensional transesophageal echocardiographic images of the short axis of the left ventricle at the level of the papillary muscles were obtained after sonicated Renografin-76 microbubbles were injected into an aortic root and/or transatrial coronary sinus catheter during delivery of cardioplegic solution. Segmental distribution of cardioplegic solution was immediately noted in the myocardium at the time of contrast injections. In 11 of 18 patients (61%) cardioplegic solution was dispersed to all left ventricular myocardial segments after antegrade delivery. In 17 of 19 patients (90%) retrogradely delivered cardioplegic solution (after antegrade induction of cardioplegia in 18 of the 19 patients) was dispersed to all the left ventricular myocardial segments, including the septum. In 2 of the patients, initial lack of retrograde distribution of cardioplegic solution was remedied when the coronary sinus catheter was repositioned and contrast cardioplegic solution was reinjected. Imaging of the right ventricle was possible in only 4 of the 19 patients and revealed that after retrograde delivery, cardioplegic solution had been at least partially distributed to the right ventricle as well. We performed off-line videodensitometric analysis in 9 patients after retrograde delivery of cardioplegic solution. Mean peak pixel-intensity ratio of flow from the endocardium to the epicardium in the left ventricular free wall was 1.46 +/- 0.27, and mean peak pixel-intensity ratio of flow from the left to the right intraventricular septal endocardium was 1.39 +/- 0.33 (p < or = 0.05).
在19例患者中，通过对比超声心动图直接评估并比较了经主动脉根部诱导心脏停搏后，心脏手术干预中顺行和逆行心脏停搏液在心肌中的分布情况。在心脏停搏液输送过程中，将超声处理的泛影葡胺-76微泡注入主动脉根部和/或经心房冠状窦导管后，获取乳头肌水平左心室短轴的二维经食管超声心动图图像。在注入对比剂时，立即记录心脏停搏液在心肌中的节段性分布。18例患者中有11例（61%）在顺行给药后心脏停搏液分散至左心室所有心肌节段。19例患者中有17例（90%）逆行输送的心脏停搏液（19例患者中有18例在顺行诱导心脏停搏后）分散至左心室所有心肌节段，包括室间隔。2例患者在重新放置冠状窦导管并再次注入对比心脏停搏液后，最初心脏停搏液逆行分布不足的情况得到纠正。19例患者中只有4例能够对右心室进行成像，结果显示逆行给药后，心脏停搏液至少部分也分布到了右心室。在9例患者逆行输送心脏停搏液后，我们进行了离线视频密度分析。左心室游离壁从心内膜到心外膜的血流平均峰值像素强度比为1.46±0.27，左、右心室内间隔心内膜之间的血流平均峰值像素强度比为1.39±0.33（p≤0.05）。
