<原著>冠再灌流時の実験的残存狭窄の心筋salvageに及ぼす影響

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The limitation of myocardial salvage caused by coronary arterial stenosis which persisted after coronary reperfusion is shown in this study. The coronary artery was occluded for one hour in 51 dogs. At reperfusion, 8 dogs were allowed to reperfuse without residual stenosis (group A). Nine dogs had residual stenosis of 99% without contrast washout delay at the initial 6 hours of reperfusion and were then fully reperfused (group B). In group C (n=8), the same residual stenosis was sustained for 7 days. In group D (n=10), 99% stenosis with contrast washout delay was maintained for 6 hours and then were fully reperfused. In group E (n=8), another 5 hours of occlusion was added following the initial 1 hour occlusion and then were fully reperfused. In group F (n=8), the artery was occluded for 7 days. Coronary angiography was performed on the lst day every hour and then 7 days later to confirm the stenosis. Eight hours after initiation of coronary occlusion, the chest was closed and all dogs were bled for 7 days. Percent systolic wall thickening measured 7 days later at the occluded portion revealed systolic thickening in group A and B, almost no thickening in group C, D and E, and systolic thinning in group F. This suggests that the smaller the residual stenosis, the better the functional recovery. Myocardial creatine phosphokinase activity (CK) at the inner layer was depleted similarly in group A (43.8±12.5% of control) and B (46.5±7.4). This depletion was more marked in group C (26.6±8.4%) in which 99% stenosis was sustained for 7 days. Groups D, E, F had more marked myocardial depletion (11.3±3.7,13.3±2.6,9.3±3.3%, respectively). Anatomical infarct size was the smallest in group A (6.8±3.6%), largest in group F (62.6±9.8%), the other groups being intermediate, roughly in the order of residual stenosis (B : 13.2±3.7,C : 25.2±6.2,D : 27.0±5.5,E : 25.3±6.3%). These results indicate that the residual stenosis of 99% without contrast washout delay has little effect provided it persisted only for 6 hours but is deleterious if it is sustained for 7 days. Ninety-nine percent stenosis with contrast washout delay has no advantage for myocardial salvage.
近畿大学の論文
1990-03-25

<原著>冠再灌流時の実験的残存狭窄の心筋salvageに及ぼす影響

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