The significance of coronary arterial stenosis during cardiopulmonary bypass
| Autor: | Ramesh Chandra, Arthur D. Boyd, Frank C. Spencer, Richard M. Engelman |
|---|---|
| Rok vydání: | 1975 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Arterial stenosis business.industry medicine.disease law.invention Coronary arteries Stenosis medicine.anatomical_structure Ventricle law Internal medicine cardiovascular system medicine Cardiology Cardiopulmonary bypass Surgery cardiovascular diseases Circumflex Myocardial infarction Cardiology and Cardiovascular Medicine business Perfusion |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 70:869-879 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/s0022-5223(19)39670-9 |
| Popis: | Myocardial infarction may develop during an uneventful open-heart operation. In order to better understand this complication, we undertook an experimental study. The left circumflex coronary artery of 20 dogs was narrowed to 50 per cent of its area by a metal screw clamp to produce a localized coronary stenosis. Regional myocardial perfusion in the distribution of both the stenotic circumflex and normal left anterior descending (LAD) coronary arteries was measured by injection of a radioactive-labeled microsphere (15 ± 5 μ). Circumflex coronary artery flow was measured with an electromagnetic flow probe. An epicardial electrogram was recorded in the distribution of the left circumflex. Measurements of regional myocardial perfusion, circumflex flow, and the epicardial electrogram were performed in each animal during the control (prebypass) state and during cardiopulmonary bypass with a beating and fibrillating ventricle. Half the animals had cardiopulmonary bypass performed at 50 mm. Hg perfusion pressure and half at 100 mm. Hg. The animals were put to death at the end of the study, and the hearts were sectioned, weighed, and counted. A cast was made of the stenotic circumflex coronary artery, the degree of stenosis is measured, and the per cent area stenosis calculated. The study showed that the effect of a 50 per cent coronary stenosis in reducing distal flow is apparent only during cardiopulmonary bypass at reduced pressure. The mechanism whereby a myocardial infarction develops during cardiopulmonary bypass could evolve from the development of a “critical” stenosis out of a mild-moderate one at a reduced perfusion pressure during cardiopulmonary bypass. |
| Databáze: | OpenAIRE |
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