The relationship of myocardial stroke work to coronary flow velocity immediately after aortic valve replacement

被引:4
作者
Jin, XY
Gibson, DG
Pepper, JR
机构
[1] Royal Brompton Hosp, Dept Cardiac Surg, London SW3 6NP, England
[2] Royal Brompton Hosp, Dept Cardiol, London SW3 6NP, England
基金
英国惠康基金;
关键词
D O I
10.1016/S0003-4975(99)00076-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. The interrelations between myocardial stroke work and coronary flow velocity have not been fully defined during aortic valve replacement or with different cardioplegias. Methods. Twenty-six patients (15 men age 63 +/- 13 years) who had elective isolated aortic valve replacement were studied by transesophageal Doppler echocardiography with simultaneous high fidelity left ventricular pressure. Fifteen patients received cold blood cardioplegia and 11 had warm blood cardioplegia. Myocardial stroke work and flow velocities in proximal left anterior descending coronary artery were quantified simultaneously before cardiopulmonary bypass and at 1, 6, 12, and 20 hours afterwards. Results. Myocardial stroke work decreased postoperatively in both groups (160 +/- 19 versus 228 +/- 19 mJ/cm(3) per minute, with cold blood cardioplegia; 135 +/- 22 versus 227 +/- 22 mJ/cm(3) per minute with warm blood cardioplegia; both p < 0.001 versus time, but p > 0.05 versus cardioplegia, by two-way analysis of variance). Left anterior descending artery now velocity-time integral per minute increased significantly in both groups (26.1 +/- 2.1 versus 15.0 +/- 2.1 m/min with cold blood cardioplegia; 32.8 +/- 2.5 versus 14.4 +/- 2.5 m/min with warm blood cardioplegia; both p < 0.001 versus time, but p > 0.05 versus cardioplegia). Thus, at 1 hour postoperatively the mJ . cm(-3) . m(-1). min ratio of myocardial stroke work to left anterior descending artery now velocity-time integral decreased significantly in both groups (4.3 +/- 1.6 versus 16.3 +/- 1.7 mJ . cm(-3) . m(-1) . min with warm blood cardioplegia, and 7.4 +/- 1.4 versus 17.9 +/- 1.4 J . cm(-3) . m(-1) . min with cold blood cardioplegia; both p < 0.001 m versus time). Warm blood cardioplegia was also associated with a lower mean ratio perioperatively than that with cold blood cardioplegia (7.8 +/- 0.9 versus 10.9 +/- 0.7 mJ . cm(-3) . m(-1) . min, p = 0.014). Conclusions. Coronary hyperemia occurs for at least 20 hours postoperatively when myocardial stoke work has decreased. The ratio of myocardial stroke work to coronary now velocity appears to be more sensitive than either alone in differentiating the effect of warm versus cold blood cardioplegia. (Ann Thorac Surg 1999;67:705-10) (C) 1999 by The Society of Thoracic Surgeons.
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页码:705 / 710
页数:6
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