補助人工心臓に関する実験的並びに臨床的研究 : 左心補助効果及び全身循環維持からの検討
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The effects of left ventricular assist device (LVAD) were studied experimentally in swine with cardiogenic shock due to acute myocardial infarction (AMI). Hemodynamics, EVR, serum enzymes and pathological findings were precisely evaluated in early stage after the initiation of the LVAD. On the other hand on the basis of these excellent results of the experimental studies, clinical study was carried out in two patients with ventricular septal rupture following AMI and reoperation for multiple valvular disease. (Ma terials and methods) Twenty-one swine were used in this experimental study and AMI was made by means of multiple ligations of the coronary arteries. These swine were devided into groups as follows. In group I (10 swine), only ligations of the coronary arteries were done as a control group. In group II (11 swine), LHB (by diaphragm type VAD) treated as an experimental group. (Results and conclusions) 1) Ventricular fibrilation occured in 11 out of 21 swine after production of AMI and mean percentage of the infarcted area of LV of LV free wall by means of NBT stainig was 63%. 2) By application of LVAD for the profound failing heart, a significant decrease of LV max dp/dt and TTI and a marked increase of EVR were observed. Besides a diminished left ventricular preload and afterload, a decrease of the cardiac work and an increase of the coronary blood flow could be obtaind. 3) During LVAD a satisfactory systemic circulatory support could be maintained in aortic pressure more than 90mmHg. 4) No right cardiac function was changed even by utilization of LVAD. 5) The limitation for left ventricular assist by only LVAD exists in about 1800 dyne sec cm^<-5> from the view of pulmonary vascular resistence (PVR). 6) Clinical application of LVAD was emphasized in two cases with profound heart failure. Subsequently an improvement of cardiac function and a systemic circulatory support were obviously confirmed.
- 神戸大学の論文
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