选择性冠状静脉动脉化后心肌微血管水平再灌注质量

目的:评估选择性冠状静脉动脉化对慢性缺血心肌微血管水平的灌注质量和心肌收缩功能的影响。方法:建立杂种犬慢性心肌缺血模型,采用结扎心大静脉(GCV)近心端,游离左内乳动脉(LIMA)与 GCV行端侧吻合,建立静脉动脉化逆行灌注模型。采用心肌声学造影(MCE)观察缺血区微血管水平的声学密度并判断其再灌注质量。心脏超声测定左室射血分数(LVEF)及左室前壁收缩期增厚率(AWT),评价心肌收缩功能。结果:经冠状静脉动脉化后缺血区心肌微血管水平声学密度明显提高,LVEF及AWT均明显增加(均P<0.05)。结论:选择性冠状静脉动脉化能有效提高慢性缺血区心肌微血管水平的血流灌注,从而增强心肌收缩功能。

Quality of reperfusion at microvascular level after selective coronary venous arterialization

Objective:To investigate the quality of reperfusion at a microvascular level and myocardial function after a retrograde coronary venous bypass graft to left ventricle. Method:Following the dog model of chronic myocardial ischemia of left ventricle was established, the left internal mammary artery (LIMA)-great cardiac vein(GCV)anastomasis was completed. After GCV occlusion at proximal, retrograde coronary venous perfusion was afforded. At 6 weeks, acoustics density at microvascular level of chronic myocardial ischemia-reperfusion territories was measured with myocardial contrast echocardiography(MCE). The left ventricle eject fraction and left anterior wall thickness was measured also respectively. Result:The acoustics density (rogasta scale 1-2)at microvascular level was increased following selective arterialization of coronary venous system, LVEF% and AWT% significantly improved (P< 0.05). Conclusion:Selective arterialization of coronary venous system could improved the quality of reperfusion at microvascular level of chronic myocardial ischemia and enhanced myocardial function.