99Tcm-MIBI动力学变化与大鼠缺血-再灌注心肌存活的相关性研究

目的探讨用99Tcm-甲氧基异丁基异腈(MIBI)动力学变化评价心肌存活的价值.方法15只离体Krebs-Henseleit(KH)液灌注的鼠心脏,随机分成3组对照组(5只),有葡萄糖的缺血-再灌注组(IR+G组,5只),无葡萄糖的缺血-再灌注组(IR-G组,5只).用含99Tcm-MIBI(14.8MBq)的KH液灌注,观察40min的摄取和清除.用肌酸激酶(CK)分析、氯化三苯四唑(TTC)染色和透射电镜(TEM)分析研究心肌损伤程度,用放射自显影(ARG)观察99Tcm-MIBI在心肌内的分布.结果99Tcm-MIBI的摄取[每克组织百分注射剂量率(%ID/g)]在IR+G组为(7.09±0.97)%ID/g,IR-G组为(6.64±0.68)%ID/g,对照组为(11.44±1.79)%ID/g,IR-G组与IR+G组相比摄取量差异无显著性(P＞0.05),IR-G组和IR+G组与对照组相比均显著降低(P＜0.05).IR-G组99m-MIBI清除分数为(72.75±9.89)%,远高于对照组[(20.68±1.92)%]和IR+G组[(21.03±3.68)%,P均＜0.05],对照组与IR+G组的差异无显著性.99Tcm-MIBI的40min清除末滞留率在IR-G组[(1.82±0.73)%ID/g]和IR+G组[(5.61±0.89)%ID/g]远小于对照组[(9.09±1.57)%ID/g,P＜0.05],IR-G组也远小于IR+G组(P＜0.001).CK分析、TFC染色和TEM分析证明IR-G组比IR+G组有更多的心肌损伤.通过TTC染色(r=0.84,P＜0.05)和CK分析(r=-0.97,P＜0.05)确定最终99Tcm-MIBI的活度与存活心肌量高度相关,通过ARG证实99Tcm-MIBI分布于鼠心肌细胞及间质内(光镜下).结论99Tcm-MIBI的清除对代谢状态敏感,可用于评价进行性心肌损伤.     

Macrophage Depletion Suppresses Cardiac Allograft Vasculopathy in Mice

Cardiac allograft vasculopathy (CAV) is a major source of late posttransplant mortality. Although numerous cell types are implicated in the pathogenesis of CAV, it is unclear which cells actually induce the vascular damage that results in intimal proliferation. Because macrophages are abundant in CAV lesions and are capable of producing growth factors implicated in neointimal proliferation, they are leading end-effector candidates. Macrophages were depleted in a murine heterotopic cardiac transplant system known to develop fulminant CAV lesions. C57BL/6 hearts were transplanted into (C57BL/6 x BALB/c)F(1) recipients, which then received anti-macrophage therapy with intraperitoneal carrageenan or i.v. gadolinium. Intraperitoneal carrageenan treatment depleted macrophages by 30-80% with minimal effects upon T, B or NK cells as confirmed by flow cytometry and NK cytotoxicity assays. Carrageenan treatment led to a 70% reduction in the development of CAV, as compared to mock-treated controls (p = 0.01), which correlated with the degree of macrophage depletion. Inhibition of macrophage phagocytosis alone with gadolinium failed to prevent CAV. Macrophages may represent the end-effector cells in a final common pathway towards CAV independent of T-cell or B-cell alloreactivity and exert their injurious effects through mechanisms related to cytokine/growth factor production rather than phagocytosis.     

Portaclamp in video-assisted minimally invasive cardiac surgery: Surgical technique and preliminary clinical experience

Video-assisted minimally invasive cardiac surgery (VAMICS) is currently performed with various indications. However, despite the increasing evidence of its effectiveness, new approaches have to be defined to simplify this procedure, minimize its potential complications and limit its costs, for a wider use in the surgical community. The limited access to the aorta is a key point in VAMICS and mandates specific clamping modalities with their own limitations, costs and drawbacks. The Portaclamp (Cardio Life Research SA, Louvain la Neuve, Belgium), a new autoguided extravascular aortic cross-clamping system, has been recently proposed to facilitate VAMICS. Herein, we describe the Portaclamp approach and report our indications and preliminary clinical experience so to define its role in VAMICS.     

Continuous In-Line Monitoring of Oxygen Delivery to Control Artificial Heart Output

In order to evaluate the pump output control based on the oxygen delivery to peripheral tissues, arterial and mixed venous hemoglobin content ([Hb]) and oxygen saturation (SO2) were continuously monitored in three biventricular bypass animals (3-, 6-, and 40-day experiments) with fibrillating ventricles. The specially developed oxygen sensors were mounted in the outflow ports of the artificial hearts to measure [Hb] and SO2. One animal was exercised on the treadmill at 2.0 mile/h for 15 min with pump flows fixed to deliver oxygen of (a) above 13 cc/min/kg, (b) 10, and (c) 9. In (a), the mixed venous saturation (SvO2) dropped to approximately 25% with no increase in the blood lactate level. In (b) and (c), the SvO2 decreased to approximately 10-15% with increase in blood lactate levels from 4 to 10-30 mg/dl. Also, the recovery of the SvO2 in these groups following the termination of the exercise was slower in comparison to (a). The lower limit of the SvO2 level that would create oxygen debt situation in the peripheral tissues was approximately 25-30% for the exercise of 2.0 mile/h. The SvO2 reflects changes in respiratory status, pump output, hemoglobin level, and metabolism, and is thus a useful indicator to diagnose quickly the circulatory status as well as possibly to control the artificial heart output.     

心脏神经症患者直立倾斜试验探讨

目的:探讨直立倾斜试验(HUTT)对心脏神经症的诊断价值。方法:对59例心脏神经症患者,在排除器质性心脏病后行HUTT。结果:43例呈阳性,阳性发生率为72.9%。不同性别间反应类型有显著差异(P<0.05),女性多见血管抑制型(占76.9%)。不同反应类型间终末血压、心率有明显差异(P<0.05)。结论:HUTT可作为心脏神经症有效的辅助诊断方法。     

ATP和SNP控制性降压对血流动力学的影响

对比研究三磷酸腺苷（ＡＴＰ）和硝普钠（ＳＮＰ）控制性降压对氯胺酮麻醉犬血流动力学的影响。选择犬１４只，随机分为ＡＴＰ组和ＳＮＰ组，由股静脉持续输入ＡＴＰ和ＳＮＰ使ＭＡＰ降低３０％￣４０％，维持３０ｍｉｎ，分别于降压前、降压后１５ｍｉｎ、３０ｍｉｎ及停止降压后１５ｍｉｎ用Ｓｗａｎ－Ｇａｎｚ漂浮导管测定血流动力学指标。结果表明，ＡＴＰ、ＳＮＰ降压期间ＳＶＲ、ＬＶＳＷ显著降低，ＣＯ、ＰＣＷＰ、ＳＶ、ＲＶ     

Nitrate administration to enhance the detection of myocardial viability by technetium-99m tetrofosmin single-photon emission tomography

A comparison was performed between technetium-99m tetrofosmin myocardial perfusion tomography at baseline and after nitrate administration, using a 2-day protocol, and rest-reinjection thallium-201 single-photon emission tomography (SPET) studies in order to assess whether nitrates enhance the detection of viable myocardium with^99mTc-tetrofosmin. Fifteen patients with coronary artery disease, previous myocardial infarction and a left ventricular ejection fraction <40% underwent²⁰¹T1 rest-injection and^99mTc-tetrofosmin. baseline-postnitroglycerin (0.4 mg sublingually) SPET studies, within 48 h. Tomograms based on the three spatial planes were divided into 15 segments and regional tracer uptake was quantitatively analysed. Viability was defined as presence of tracer uptake >50% of peak activity on baseline studies or after reversibility. The percentage of peak activity of^99mTc-tetrofosmin at baseline correlated with that of 201T1 (r=0.82,P <0.001). On baseline^99mTc-tetrofosmin studies, 73 of the 225 segments that were analysed had <50% of peal. activity. Fifteen percent of these segments showed reversibility after nitrate administration, with an increase in^99mTc-tetrofosmin uptake from 40%±9% to 57%±9% of peak activity (P=0.003). All reversible segments after nitrate administration had viability criteria on²⁰¹Tl studies, but 20 segments that were non-viable on^99mTc-tetrofosmin. studies were viable on²⁰¹Tl studies. Using a threshold value of >40% of peak activity, only seven segments remained non-viable on^99mTc-tetrofosmin studies. Overall agreement between^99mTc-tetrofosmin with nitrates and²⁰¹Tl-reinjection regarding the presence of myocardial viability was 90%. Detection of myocardial viability with^99mTc-tetrofosmin. was enhanced after nitrate administration, correlating with viability criteria observed on thallium studies.     

Myocardial protection in adult cardiac surgery: current options and future challenges

Current techniques of myocardial protection are evolving with the use of less conventional modalities of cardioplegia and have reduced the morbidity and mortality of cardiac operations. Blood cardioplegic solutions appear superior to cold cardioplegia in terms of myocardial protection and adjuncts as glutamate/aspartate enhancement, antioxidant supplementation, nitric oxide donors and maintenance of calcium homeostasis seem effective. In the near future, further experimental and clinical investigations about pharmacological preconditioning, sodium–hydrogen exchangers inhibition and gene therapy need to be addressed to well define their potential role in the improvement of current techniques of myocardial protection that are suboptimal in high-risk clinical settings.     

A new respiratory valve system for measuring oxygen uptake during swimming

We describe a new respiratory valve system with minimal dead space, which allows measurement of ventilation and oxygen uptake during swimming. The device offers considerable advantages in efficiency and accuracy over current equipment, and can be used in conjunction either with a miniaturized telemetry system for oxygen uptake measurement or with a conventional system. The valve has a low airflow resistance, a small dead space (15 ml), and an electrically operating, closed-circuit pump to remove excess water from the expiratory tube. The external form and the buoyancy of the valve have been hydrostatically and hydrodynamically designed to reduce drag and to ensure a correct mass in the water. To obtain this result a very sophisticated material, carbon fibre, has been utilized. Our studies showed that this respiratory system is ideal for obtaining valid and reliable values of oxygen uptake during swimming, even at high speed and in endurance swimming tests.     

The cold pressor test: Vascular and myocardial response patterns and their stability

The purposes of the present study were to compare the cardiovascular response patterns evoked by three versions of the cold pressor test (either forehead stimulation or hand or foot immersion) and to determine the reproducibility of the responses over a 2-week interval. Blood pressure, heart rate, stroke volume, cardiac output, total peripheral resistance, and systolic time intervals were obtained during rest and during the cold pressor test in 42 young men. Across conditions, the pressor response was supported by peripheral resistance increases with concomitant stroke volume decreases. Although the response panerns were generally similar across sites, exceptions were apparent for heart rate. Forehead stimulation was characterized by no significant change in heart rate, whereas limb (hand or foot) immersion was associated with significant heart rate acceleration. The responses elicited by the three cold pressor test conditions were reliable and showed little evidence of attenuation over the test-retest interval.