Schultz L S, Ferguson R M, Pliam M B, Motsay G J, Lillehei R C
Eur Surg Res. 1976;8(5):358-76. doi: 10.1159/000127881.
Retroperfusion of the superficial coronary venous system was studied in 44 canine fibrillating in vivo, normothermic preparations, with exclusion of the systemic circulation using cardiopulmonary bypass techniques in order to assess its value as a method of myocardial revascularization. Perfusion of either the isolated aortic arch via a brachiocephalic cannula or of the coronary sinus through the free end of a vein anastomosed to the atrial rim of the sinus was performed for 1 h at 100 cm3/min in groups II-IV following 30 min of anoxia. Oxygen uptake, vascular resistance, venous outflow and venous enzyme levels (CPK, GDH) were studied. Group I controls (antegrade perfusion, no anoxia) showed continued aerobic metabolism in contrast to group II (antegrade perfusion) and III (retrograde perfusion) which displayed negative lactate balance. Oxygen consumption was greater in group III than II (p less than 0.01) with a higher oxygen extraction in III (p less than 0.005). Group IV, which was given intravenously 30 mg/kg methylprednisolone prior to anoxia and then retroperfused, showed continued aerobic metabolism with low GDH venous levels and adequate oxygen consumption. Three dogs were then subjected to aortoatrial rim coronary sinus vein grafts with ligation of the left common coronary artery at its bifurcation with distal left circumflex and anterior descending artery-internal mammary vein anastomoses for venous drainage. The right coronary artery was left intact. Arterial inflow into the coronary sinus was associated with a left ventricular pressure of 70-80 mm Hg for up to 1.5 h while regular sinus rhythm was maintained. We conclude that retroperfusion of the coronary sinus represents a surgically feasible technique for providing oxygen delivery to the ischemic myocardium.
在44只处于体内常温状态、正在发生颤动的犬身上，利用体外循环技术排除体循环，对浅表冠状静脉系统的逆向灌注进行了研究，以评估其作为心肌血运重建方法的价值。在缺氧30分钟后，对第II-IV组通过头臂静脉插管对孤立的主动脉弓进行灌注，或通过与冠状窦心房边缘吻合的静脉游离端对冠状窦进行灌注，灌注速度为100 cm³/分钟，持续1小时。研究了氧摄取、血管阻力、静脉流出量和静脉酶水平（肌酸磷酸激酶、谷氨酸脱氢酶）。第I组对照组（顺行灌注，无缺氧）显示持续的有氧代谢，与之形成对比的是，第II组（顺行灌注）和第III组（逆行灌注）呈现负乳酸平衡。第III组的氧消耗量高于第II组（p<0.01），第III组的氧摄取率更高（p<0.005）。第IV组在缺氧前静脉注射30 mg/kg甲泼尼龙，然后进行逆向灌注，显示出持续的有氧代谢，静脉谷氨酸脱氢酶水平较低，氧消耗量充足。然后对3只犬进行主动脉-心房边缘冠状窦静脉移植，在左冠状动脉与其分支处（左回旋支和前降支动脉）结扎，进行左冠状动脉-内乳静脉吻合以进行静脉引流。右冠状动脉保持完整。冠状动脉窦的动脉流入与左心室压力70-80 mmHg相关，可持续长达1.5小时，同时维持正常窦性心律。我们得出结论，冠状窦逆向灌注是一种手术可行的技术，可为缺血心肌提供氧输送。
