Klautz R J, van Rijk-Zwikker G L, Steendijk P, Wilde J, Teitel D F, Baan J
Department of Cardiology, University Hospital Leiden, The Netherlands.
J Thorac Cardiovasc Surg. 1997 Oct;114(4):560-7. doi: 10.1016/S0022-5223(97)70045-X.
After the Fontan operation the right atrium and, thus, the coronary sinus are connected to the pulmonary arterial system, which causes the coronary venous pressure to increase. We investigated the acute effects of elevation of coronary venous pressure on baseline hemodynamics, coronary venous flow, and left ventricular contractility.
In acutely instrumented pigs, during complete right heart bypass and during constant cardiac output, pressure in the right atrium, right ventricle, and coronary sinus was altered by a height-adjustable reservoir. At various levels of coronary venous pressure (up to 4 kPa or up to 30 mm Hg), flow from the reservoir was measured and left ventricular hemodynamics and contractility were measured from catheter-derived left ventricular pressure and (conductance) volume data. Contractility of the left ventricle was assessed by the end-systolic pressure-volume relationship derived during an unloading intervention by adjusting the bypass pump speed.
Left ventricular end-diastolic pressure increased slightly (about 5%) with each kilopascal increase in coronary venous pressure, most likely related to diastolic ventricular interaction. No other changes in hemodynamic parameters occurred. Neither coronary venous flow nor left ventricular contractility was influenced by changes in coronary venous pressure. Imposing myocardial stress with dobutamine, 10 microg/kg per minute, did not change these findings.
Increasing coronary venous pressure to 4 kPa in the intact circulation with intact autoregulation does not affect coronary flow or left ventricular contractility. We found no experimental evidence for the usefulness of diversion of the coronary sinus to the left atrium during Fontan-type operations
在Fontan手术之后，右心房以及冠状静脉窦与肺动脉系统相连，这会导致冠状静脉压力升高。我们研究了冠状静脉压力升高对基础血流动力学、冠状静脉血流以及左心室收缩性的急性影响。
在急性插管的猪身上，在完全右心旁路期间且心输出量恒定的情况下，通过一个高度可调的储液器改变右心房、右心室和冠状静脉窦的压力。在不同水平的冠状静脉压力（高达4 kPa或高达30 mmHg）下，测量来自储液器的流量，并根据导管测得的左心室压力和（电导）容积数据测量左心室血流动力学和收缩性。通过在卸载干预期间（通过调整旁路泵速度）得出的收缩末期压力-容积关系来评估左心室的收缩性。
随着冠状静脉压力每升高1 kPa，左心室舒张末期压力略有升高（约5%），这很可能与舒张期心室相互作用有关。血流动力学参数没有发生其他变化。冠状静脉血流和左心室收缩性均未受冠状静脉压力变化的影响。以每分钟10μg/kg的剂量静脉注射多巴酚丁胺施加心肌应激，并未改变这些结果。
在具有完整自动调节功能的完整循环中，将冠状静脉压力升高至4 kPa不会影响冠状血流或左心室收缩性。我们没有找到实验证据支持在Fontan型手术期间将冠状静脉窦转流至左心房的有效性。
