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| 心脏瓣膜手术期间一个有效的心脏扩大保护手段：交替心脏顺行/逆行心脏灌注 |
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| Alternate antegrade/retrograde perfusion: an effective technique to preserve hypertrophied hearts during valvular surgery |
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| Wang J., Liu H., Salerno T.A., Tomanek B., Summers R., Deslauriers R., Arora R.C., Tian G. 2009/5/29 18:39:31 |
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European Journal of Cardio-thoracic Surgery, 2009, Volume 35, Issue 1
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| Objective: Continuous antegrade perfusion (AP) may interfere with surgical precision. Continuous retrograde perfusion (RP), on the other hand, cannot sustain the empty-beating hypertrophied hearts. Therefore, alternate antegrade/retrograde perfusion (AA/RP) may be a rational technique to preserve the hypertrophied hearts. This study is to determine whether AA/RP could maintain myocardial energy metabolism, oxygenation, and contractile function of the empty-beating hypertrophied hearts. Methods: Sixteen hypertrophied pig hearts were divided into four groups (n = 4 per group). Group I and II underwent an 80-min AA/RP (four 10-min APs and four 10-min RPs), followed by a 20-min reperfusion. Group III and IV were subjected to an 80-min AP and 20-min reperfusion and used as a control. Energy metabolism was evaluated in group I and III using magnetic resonance spectroscopy. Myocardial oxygenation (MO) was assessed in group II and IV using near infrared spectroscopic imaging. Results: During 80-min AA/RP, four episodes of RP resulted in a significant decrease in myocardial phosphocreatine (PCr) and MO. The subsequent AP, however, resulted in complete recovery of the parameters. Moreover, myocardial adenosine triphosphate (ATP) remained at a normal level throughout the 80-min AA/RP. As expected, hearts in groups III and IV showed normal level of myocardial PCr, ATP, and MO throughout protocol. Finally, hearts in all four groups showed similar contractile function during reperfusion. Conclusions: AA/RP with four 10-min intervals of AP and RP sustained normal myocardial energy metabolism, oxygenation, and contractile function of empty-beating hypertrophied hearts. We conclude that AA/RP is an effective technique for preservation of empty-beating hypertrophied hearts during valvular surgery. © 2008 European Association for Cardio-Thoracic Surgery. |
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| Correspondence Address: Tian, G.; Institute for Biodiagnostics, National Research Council, 435 Ellice Avenue, Winnipeg, Man., Canada; email: Hong.Tian@nrc-cnrc.gc.ca |
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 疾病资源中心
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
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