Myocardial Protection for Open Heart Operation in Infancy; Experimental and Clinical Studies

在对动物进行实验性研究之后，我们开始使用放射性冠状动脉灌注（RCSP）的临床用途与心脏病解决方案（4 ° C圣托马斯医院解决方案）进行心肌保护，在传统的选择性冠状动脉灌注在任何常规选择性冠状动脉灌注中可能是技术上的困难。这一方法产生了一个非常简单的操作程序，并带来了很多更好的外科结果。我们目前的研究是针对这一方法对微小开放式心脏操作的进一步应用，特别是TGA （Jatene）在其中的操作程序更加复杂，带来了不可避免的和更多的差异性的myocardial保护。使用mongl dogs， myocardial ischemia被认为是由atic crossclamping和Obstruction在CPB下的左主要coronary aries。在90分钟后，冠状植物被释放了，并被重新使用，以释放了航空交叉灯和左冠状构造。肌肉温度、钙、pH值、氧和乳酸的升高，ATP被测量。RCSP-小组展示了一种比常规反融合组更好的myocardial冷却。剩余的实验结果也是RSP-Group中左肠道肌钙的饱和度因子。因此，这一方法是特定开放心脏操作中肌钙保护的一个极好的替代方案。However，正确的肠道myocardium的罕见不充分的渗透已经被点出来，成为这一方法的一个倒退。我们研究了狗在1） RCSP与正确ventricle的主题冷却， 2） RCSP没有主题冷却，以及3）常规反融合。在没有RCSP的情况下，在没有主题冷却的情况下，明确地在狗组中进行了60分钟的生理功能。这意味着在RCSP时间的重要性。

After the experimental study in annimals, we started the clinical use of retrograde coronary sinus perfusion (RCSP) with the cardioplegic solution (4゜C St Thomas Hospital solution) for myocardial protection in these particular patients with aortic valve operation in which conventional selective coronary perfusion might be technically difficult. This method has made the operative procedures extremely easy and brought much better surgical results. Our present studies are aiming further application of this method to the infant open heart operations, particularly the anatomic correction of TGA (Jatene) in which operative procedures are more complicated, bringing inevitably more difficult myocardial protection.Using the mongrel dogs, myocardial ischemia was induced by aortic crossclamping and obstruction of the left main coronary artery under CPB. After 90 minutes of ischemia, coronary arteries were reperfused by releasing the aortic crossclamp and left coronary obstruction. Myocardial temperature, Pco , pH, oxygen and lactate uptake and ATP were measured. RCSP-group showed a better myocardial cooling than the group with conventional antegrade perfusion. The rest of the experimental results also demonstrated satisfactory perfusion of the left ventricular myocardium in RCSP-group.Thus, this method will be an excellent alternative for myocardial protection in particular open heart operation. However, occasional insufficient perfusion of the right ventricular myocardium has been pointed out to be a drawback of this method. We studied right ventricular functions of the dogs in 1) RCSP with topical cooling of the right ventricle, 2) RCSP without topical cooling and 3) conventional antegrade perfusion. Right ventricular function after 60 minutes of ischemia deminished significantly in the group of dogs in RCSP without topical cooling. This means the importance of right ventricular topical cooling at the time of RCSP.