Gates R N, Laks H, Drinkwater D C, Pearl J, Zaragoza A M, Kaczer E, Chang P
Department of Surgery, University of California, Medical Center, Los Angeles 90024.
J Thorac Cardiovasc Surg. 1993 May;105(5):845-52; discussion 852-3.
The uniform distribution of cardioplegic solution to all areas of the microvasculature is considered critical for myocardial protection. Despite this, little information exists regarding the ability of retrogradely infused cardioplegic solution to perfuse the microvasculature of the heart. In this report, the microvascular distribution of retrogradely delivered cardioplegic solution was studied by means of a technique to quantitatively demonstrate capillary perfusion. Duroc piglet hearts were subjected to either antegrade (n = 4) or retrograde (n = 8) perfusion fixation with 2.5% glutaraldehyde and subsequently perfused with NTB-2 (an intracapillary marker). The results indicate that retrogradely delivered NTB-2 consistently perfused the anterior half of the intraventricular septum and the anterior and lateral free walls of the left ventricle but inconsistently perfused the posterior half of the intraventricular septum, the posterior wall of the left ventricle, and a small paraseptal region of the right ventricle. The remainder of the right ventricle was not perfused. In contradistinction, all regions of the heart were consistently perfused by the antegrade technique. In regions of the heart in which retrograde microvascular perfusion occurred, no statistical difference was found in the quantitative degree of capillary perfusion achieved by either the antegrade or retrograde technique. These results have important implications for planning strategies of myocardial protection and suggest that further investigation concerning the microvascular distribution of retrogradely delivered cardioplegic solution in human beings is merited.
心脏停搏液在微血管系统各区域的均匀分布被认为对心肌保护至关重要。尽管如此，关于逆行灌注的心脏停搏液灌注心脏微血管系统能力的信息却很少。在本报告中，通过一种定量显示毛细血管灌注的技术，研究了逆行递送的心脏停搏液的微血管分布情况。将杜洛克仔猪心脏用2.5%戊二醛进行顺行灌注固定（n = 4）或逆行灌注固定（n = 8），随后用NTB - 2（一种毛细血管内标记物）进行灌注。结果表明，逆行递送的NTB - 2始终能灌注到室间隔前半部分以及左心室的前壁和侧壁，但对室间隔后半部分、左心室后壁以及右心室的一个小的间隔旁区域的灌注并不一致。右心室的其余部分未被灌注。相比之下，通过顺行技术心脏的所有区域都能持续得到灌注。在心脏发生逆行微血管灌注的区域，顺行或逆行技术在毛细血管灌注的定量程度上未发现统计学差异。这些结果对心肌保护策略的制定具有重要意义，并表明值得对人类中逆行递送的心脏停搏液的微血管分布进行进一步研究。
