Kohmoto T, Argenziano M, Yamamoto N, Vliet K A, Gu A, DeRosa C M, Fisher P E, Spotnitz H M, Burkhoff D, Smith C R
Department of Surgery, Columbia University, New York, NY 10032, USA.
Circulation. 1997 Mar 18;95(6):1585-91. doi: 10.1161/01.cir.95.6.1585.
Techniques for achieving myocardial perfusion directly from the left ventricular chamber are currently under investigation. Although originally based on the anatomy of reptilian hearts, which are rich in transmural channels and reported to have a poorly developed coronary vasculature, the blood flow capacity of a transmyocardial blood supply has not been studied in these hearts. With the ultimate goal of providing insight into the potential for achieving transmyocardial perfusion in human hearts, we studied the relative contribution of transmyocardial and coronary perfusion in alligator hearts.
After explanation from six American alligators, the left ventricle was instrumented, and coronary arteries were perfused with oxygenated physiological solution. Using microspheres to estimate regional myocardial perfusion in the beating hearts, we show that although the epicardium was well perfused by the coronary arteries (0.20 +/- 0.08 versus 0.07 +/- 0.01 mL.min-1.g-1 owing to flow from the ventricular chamber), a significant proportion of endocardial perfusion was from the ventricular chamber (0.21 +/- 0.07 mL.min-1.g-1 from the left ventricle versus 0.13 +/- 0.04 mL.min-1.g-1 from coronary arteries).
A significant amount of direct transmyocardial perfusion is present in alligator hearts. The conditions that apparently permit this situation in reptilian hearts are reviewed, and their implications for aiding in the optimization of techniques for achieving transmyocardial flow in humans are discussed.
目前正在研究直接从左心室实现心肌灌注的技术。尽管最初是基于爬行动物心脏的解剖结构，其富含透壁通道且据报道冠状动脉血管系统发育不良，但尚未对这些心脏中经心肌血液供应的血流能力进行研究。为了深入了解在人类心脏中实现经心肌灌注的潜力这一最终目标，我们研究了短吻鳄心脏中经心肌灌注和冠状动脉灌注的相对贡献。
在对六只美国短吻鳄进行解释后，对左心室进行插管，并向冠状动脉灌注含氧生理溶液。使用微球来估计跳动心脏中的局部心肌灌注，我们发现尽管冠状动脉对心外膜的灌注良好（由于来自心室腔的血流，为0.20±0.08与0.07±0.01 mL·min⁻¹·g⁻¹），但相当一部分心内膜灌注来自心室腔（来自左心室为0.21±0.07 mL·min⁻¹·g⁻¹，而来自冠状动脉为0.13±0.04 mL·min⁻¹·g⁻¹）。
短吻鳄心脏中存在大量直接经心肌灌注。回顾了在爬行动物心脏中显然允许这种情况存在的条件，并讨论了它们对协助优化人类经心肌血流技术的意义。
