在接受冠状动脉旁路移植术的患者中，侧支血流可防止在顺行性心脏停搏期间发生意外的心肌缺血。

Collateral flow prevents unintentional myocardial ischemia during antegrade cardioplegia in patients undergoing coronary artery bypass grafting.

作者信息

Caretta Q, Voci P, Acconcia M C, Chiarotti F

机构信息

University of Florence, Italy.

出版信息

J Thorac Cardiovasc Surg. 1997 Mar;113(3):585-93. doi: 10.1016/S0022-5223(97)70374-X.

DOI:10.1016/S0022-5223(97)70374-X

PMID:9081106

Abstract

OBJECTIVE

We evaluated, in the prevention of perioperative unintentional myocardial ischemia, the role of coronary collateral flow in patients with left anterior descending coronary artery stenosis or occlusion who underwent elective coronary artery bypass grafting.

METHODS

Coronary lesions and collaterals were assessed by coronary angiography in 21 patients. Anteroseptal myocardial viability was evaluated by dobutamine echocardiography. Antegrade perfusion of cardioplegic solution was assessed by myocardial contrast echocardiography. Time-intensity curves were generated from the anteroseptal region. Twelve parameters were measured and averaged in the following four groups of patients: those with stenosis of the left anterior descending artery and poor collaterals; those with stenosis of the left anterior descending artery and good collaterals; those with occlusion of the left anterior descending artery and good collaterals; and those with occlusion of the left anterior descending artery and poor collaterals.

RESULTS

Time-intensity curves were significantly different in patients with stenosis versus occlusion of the left anterior descending artery (p < 0.005); multiple comparisons with Bonferroni's correction showed that this difference was mainly a result of the impact of collateral circulation (p < 0.01). However, the role of collaterals was nonsignificant within the groups with stenosis and occlusion of the left anterior descending artery. Patients with occlusion of the left anterior descending artery and good collaterals had perfusion parameters similar to those of patients with stenosis of the left anterior descending artery (p = not significant), except for the ascending slope and time to peak values (p < 0.05 and p < 0.01, respectively), which reflected a higher flow resistance in the collateral circulation. Regional systolic function after coronary artery bypass grafting was depressed in patients with poor collaterals and poor perfusion of cardioplegic solution, as compared with findings in other subgroups.

CONCLUSIONS

Incomplete myocardial protection may impair the early recovery of function after coronary artery bypass grafting.

摘要

目的

我们评估了在预防围手术期非故意性心肌缺血方面，冠状动脉侧支血流在接受择期冠状动脉旁路移植术的左前降支冠状动脉狭窄或闭塞患者中的作用。

方法

通过冠状动脉造影评估21例患者的冠状动脉病变和侧支情况。用多巴酚丁胺超声心动图评估前间隔心肌活力。用心肌对比超声心动图评估心脏停搏液的顺行灌注。从前间隔区域生成时间-强度曲线。在以下四组患者中测量并平均12个参数：左前降支动脉狭窄且侧支差的患者；左前降支动脉狭窄且侧支好的患者；左前降支动脉闭塞且侧支好的患者；左前降支动脉闭塞且侧支差的患者。

结果

左前降支动脉狭窄与闭塞的患者时间-强度曲线有显著差异（p < 0.005）；经Bonferroni校正的多重比较显示，这种差异主要是侧支循环影响的结果（p < 0.01）。然而，在左前降支动脉狭窄和闭塞的组内，侧支的作用不显著。左前降支动脉闭塞且侧支好的患者的灌注参数与左前降支动脉狭窄的患者相似（p = 无显著差异），但上升斜率和峰值时间除外（分别为p < 0.05和p < 0.01），这反映了侧支循环中较高的血流阻力。与其他亚组相比，侧支差且心脏停搏液灌注差的患者冠状动脉旁路移植术后的区域收缩功能降低。