A study about total pulmonary replacement with artificial implantable lung.

目前，RVAD通常用于右心室衰竭（RVF）。在临床上，裂谷热患者通常因心力衰竭而导致气体交换不良。本研究的目的是探讨右心室（RV）至左心房（LA）旁路无泵ECMO是否可以作为治疗慢性裂谷热的一种有效手段。实验一：对10只体重2.5 ~ 6.0 kg，平均3.9kg的杂种狗进行肺动脉主干绑扎术，目的是治疗肺动脉高压引起的裂谷热。长期饲养（97-205天，平均160天）后进行右心压力研究。所有病例平均右心室压（m-RVP） [mmHg] >=20（平均30.2(]SY.+- . [)9.0 mmHg）。实验二世。10只RVF模型在RV出口和LA之间植入人工肺（MENOX EL2000, Kuraray Co.Japan）。由于术中失去1只动物，我们用9只动物（4.8-8.4kg，平均6.5kg）来评估气体传递和心功能。所有病例RV-LA分流后m-RVP（平均20.7(]SY.+- . [)4.2mmHg）均与术前相等或下降，心功能平均有改善的趋势。实验三。实验二结束后，对9只犬进行mPA结扎，并开始全RV-LA旁路。9只RVF模型5只（4.8 ~ 8.4kg，平均6.6kg）被支撑超过6小时，并评估气体传递和心功能（I组），其余4只因RVF结扎mPA后很快死亡。5只无pa带膜的杂种犬作为对照（II组）。组I和组II表现出良好的气体传输速率，平均为32.5 (]SY.+-。() 8.3毫升/分钟。(2)和(2).(5).+-。() 11.6毫升/分钟。血流量0.68（±±）。[) 0.19升/分…]在裂谷热模型中，RV-LA与市售膜氧合器之间的部分旁路比完全旁路能更好地恢复裂谷热。

At present, RVAD is commonly used for a right ventricular failure (RVF). In clinic, RVF patients usually suffer poor gas exchange due to cardiac failure. The purpose of this study is whether pumpless ECMO in right ventricle (RV) to left atrium (LA) bypass could be useful as a means of a treatment for a chronic RVF.Experiment I.Ten mongrel dogs (2.5-6.0 kg, mean 3.9kg) were performed banding of the main pulmonary artery (mPA), aimed for RVF due to pulmonary hypertension.A pressure study of the right heart was performed after a long term raising (97-205 days, mean 160 days). All the cases showed the mean RV pressure (m-RVP) [mmHg] >=20 (average 30.2(]SY.+-。[)9.0 mmHg).Experiment II.Implantation of the artificial lung (MENOX EL2000, Kuraray Co.Japan) was performed between RV outlet and LA for ten of the RVF model. As we lost one animal during operation, nine (4.8-8.4kg, mean 6.5kg) were used to evaluate the gas transfer and cardiac function. All the cases showed the m-RVP (average 20.7(]SY.+-。[)4.2mmHg) after the RV-LA hypass was equal to the preoperative value or dropped, and the average cardiac function tended to be improved. Experiment III.After experiment II,the nine dogs were performed ligation of mPA and total RV-LA bypass was started. Five (4.8-8.4kg, mean 6.6kg) of nine RVF model were supported over 6 hours and evaluated the gas transfer and cardiac function (group I), while the other four died soon after ligation of mPA due to RVF.Five non-PA banding mongrels with the membrane oxygenator were used as control (Group II). Group I,as well as Group II,showed good gas transfer rates, averages of 32.5 (]SY.+-。[) 8.3ml/min.of 02 and 37.2 (]SY.+-。[) 11.6ml/min.of CO2 with a blood flow rate of 0.68 (]SY.+-。[) 0.19 L/min..A partial bypass between RV-LA with the commercially available membrane oxygenator provides better recovary of RVF than a total bypass in RVF model.