心不全に対する体外補助循環の実験的ならびに臨床的研究

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The purpose of this paper is to report satisfactory prolonged mechanical support with Extracorporeal Assisted Circulation (EAC) for a failed heart, i. e. partial perfusion with a pump-oxygenator or the pump alone. The apparatus for EAC consists of a venous reservoir a metal-finger pump (SIGMA-MOTOR Model TM-2) and a foam oxygenator which may be used if it becomes necessary. A venous cannula is inserted through either one of the jugular or femoral veins into the vena cava near the right atrium. A part of the vena caval blood then is withdrawn by gravity drainage, and pumped into the aorta through an arterial cannula inserted into one of the femoral arteries; however, during the periods the oxygenator is used, the oxygenated blood is perfused. A) EXPERIMENTAL STUDIES 1) Prolonged partial perfusion with a pump-oxygenator was applied to healthy mongrel dogs. The cardiac output, the aortic pressure curve, the electrocardiogram, the arterial and venous pressures, and various physical signs were recorded. Aortography was performed by injecting 1ml of 76% Urografin per kg of body weight into the arterial line during the perfusion. Nine of the 12 dogs survived after proprolonged perfusion and no evident histological change as a result of this procedure was found in the 3 dogs that died seemingly due to postoperative hemorrhage or technical error. The reduction of the cardiac output during the partial perfusion was approximately equal to the perfusion rate. According to the aortographic observations, an adequate flow rate of EAC should be less than 50ml/kg/min, because, below that rate, when an arterial cannula is inserted into one of the femoral arteries, embolization in the cerebral and coronary arteries can not occur. Nevertheless, in clinical application it seems reasonable to conclude that an optimal flow rate should be selected case by case. The combined aortic pressure curve due to pulsations of both the heart and pump during partial perfusion was observed ; however, as far as the subject is concerned, changes in the pressure curve may not be significant.
社団法人日本循環器学会の論文
1961-06-15

心不全に対する体外補助循環の実験的ならびに臨床的研究

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