Myocardial revascularization after acute infarction.
Myocardial revascularization after acute infarction.
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急性梗塞后心肌血运重建。
DOI：
10.1016/0002-9149(75)90494-4
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发表时间：
1975
期刊：
影响因子：
--
通讯作者：
H. Bolooki
中科院分区：
文献类型：
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作者：
H. Bolooki
本研究的目的是：(1)建立从缺血开始到再灌流的最大间隔时间，以减少梗塞面积；(2)评价梗塞面积的改变与心功能保护之间的关系。对19只狗进行了研究，其中13只犬冠状动脉左前降支暂时闭塞(1-3小时)。本文还回顾了15例患者的住院过程，其中13例在急性心肌梗死后8小时内接受了心肌血管重建术。在犬中，如果在缺血后2小时内进行再通，最终的病理性心肌梗死范围显著缩小。缺血2小时后，血管造影显示血管重建节段运动障碍，心功能受抑。在缺血3小时后，尽管冠状动脉通畅，但梗塞和运动障碍的范围比结扎左前降支时更大。在患者中，梗死后4小时以上进行血运重建的患者出现小梗塞，但左前降支血运重建后，运动障碍区域的大小(血管造影术评估)与左前降支闭合移植物的患者相似，但其对角支的移植物开放。在所有患者中，再血管化后左室运动障碍区域的范围较小，心功能明显好于因左前降支完全闭塞而未接受再血管化的患者。尽管成功地进行了血管重建术，但术后仍有跨壁梗塞的心电图证据。结果表明，犬心肌缺血时间小于2小时，人心肌缺血时间小于4小时，再灌注可显著缩小心肌梗死范围，改善心功能。然而，血管重建区域仍然存在运动障碍和心电图异常。
The purpose of this study was (1) to establish the maximal interval between the onset of ischemia and reperfusion that would permit a decrease in the size of infarction, and (2) to evaluate the relation between changes in infarct size and preservation of cardiac function. Studies were carried out in 19 dogs of which 13 had temporary (1 to 3 hours) occlusion of the left anterior descending coronary artery. The hospital course of 15 patients of whom 13 underwent myocardial revascularization within 8 hours of acute infarction was also reviewed.In dogs, the eventual pathologic infarct size was significantly reduced if reperfusion was performed within 2 hours of ischemia. After 2 hours of ischemia, the revascularized segment remained dyskinetic on angiographic assessment and cardiac function was depressed. After 3 hours of ischemia, in spite of a patent coronary artery, the extent of infarct and dykinesia was greater than during ligation of the left anterior descending coronary artery.In patients, small infarcts developed with revascularization performed more than 4 hours after infarction but with revascularization of the left anterior descending coronary artery the size of the dyskinetic area (as assessed with angiography) was similar to that in patients with a closed graft to the left anterior descending coronary artery but with a patent graft to its diagonal branch. In all patients after revascularization the extent of the left ventricular dyskinetic area was smaller and cardiac function was significantly better than in patients who did not receive revascularization for complete occlusion of the left anterior descending coronary artery. In spite of successful revascularization, electrocardiographic evidence of transmural infarction persisted postoperatively. It is concluded that reperfusion of an area of myocardium that has been ischemic for less than 2 hours in dogs or less than 4 hours in man may lead to a significant reduction in the extent of infarction as well as improvement in cardiac function. However, the revascularized area remains angiographically dyskinetic and electrocardiographically abnormal.