冠動脈空気塞栓に対する逆行性冠灌流および炭酸ガス投与の有用性に関する研究 : CCD microscopeを用いた心内膜の直接観察による評価
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概要
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Coronary air embolism (CAE) is one of fatal complications and causes hypotension, arrhythmia, and low cardiac output syndrome due to myocardial infarction. Retrograde perfusion (RP) has been reported to be an effective method on treatment of CAE in some of experimental studies. On the other hand, a portable needle-probe with a charge-coupled device (CCD) microscope to visualize the subendocardial microcirculation has been developed. There have been no reports on direct observation of the embolized gas in CAE. The purpose of the present study was to observe the gas in the subendocardium with a CCD microscope and to evaluate the role of RP as treatment of CAE and carbon dioxide (CO_2) gas insufflation for prevention of CAE. The hearts of 12 Japanese white rabbits were arrested with cold antegrade cardioplegia and then excised. The endocardium was observed with a CCD microscope. Air (0.1 ml) and CO_2 gas (0.2 ml) with blood (0.2 ml) were antegradely injected into the left anterior descending coronary artery in 6 rabbits (Group I) and in the other 6 (Group II), respectively. Then, RP was initiated through the coronary sinus with 10 mm Hg of perfusion pressure for 5 minutes, and sequently 20, 30, and 40 mm Hg each for 5 minutes. In Group I, the air was observed before RP in all the rabbits and then in 3 rabbits after 5 -minute RP and in 1 after 20-minute RP. In Group II, the CO_2 gas was not observed in 3 rabbits before RP, and disappeared within 2 minutes in the remaining 3. These results suggested that RP be an effective treatment of CAE while the ascending aorta or cardiac chamber was open and that filling the pericardial space with CO_2 gas be useful for prevention of CAE.
- 岐阜大学の論文
- 2003-03-31
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