目的:左心室辅助装置植入后右心室衰竭是一种严重的并发症,死亡率和发病率很高。在实验环境中已经证明,采用改良的Glenn分流术排除右心室的体积可以改善缺血性右心室衰竭期间的血流动力学。然而,改良格伦分流术的概念依赖于正常的肺血管阻力,这可能会限制其在某些患者中的使用。这项研究的目的是探讨在由于肺束带引起的右心室衰竭期间,采用改良的Glenn分流术进行容积排除的效果。并研究由于压力和容量超负荷而引起的右心室遗传表达的变化。
方法:通过2小时的肺束带在猪(n=11)中诱发实验性右心室衰竭。将猪随机分配到使用改良的Glenn分流术和肺束带(n=6)或单独的肺束带(n=5)作为对照组。血流动力学测量,用于遗传分析的血液样本和右心室活检在基线时进行采样,在右心室衰竭(即2小时的肺带)和1小时后,两组右心室衰竭。
结果:右心房压力从10mmHg(9.0-12)增加到18mmHg(16-22)(P<0.01),右心室压力从31mmHg(26-35)增加到57mmHg(49-61)(P<0.01)。随后用改良的Glenn分流器治疗导致右心房压力降低至13mmHg(11-14)(P=0.03)。在对照组中,右心房压力在19mmHg(16-20)时没有变化(P=0.18).右心衰竭时,与心力衰竭相关的基因上调,炎症,血管生成,负调节细胞死亡和增殖。
结论:与对照组相比,右心室衰竭期间采用改良Glenn分流的体积排除减少了静脉充血。通过基因表达变化证实了右心衰竭的状态。
OBJECTIVE: Right ventricular failure after left ventricular assist device implantation is a serious complication with high rates of mortality and morbidity. It has been demonstrated in experimental settings that volume exclusion of the right ventricle with a modified Glenn shunt can improve haemodynamics during ischaemic right ventricular failure. However, the concept of a modified Glenn shunt is dependent on a normal pulmonary vascular resistance, which can limit its use in some patients. The aim of this
study was to explore the effects of volume exclusion with a modified Glenn shunt during right ventricular failure due to pulmonary banding, and to
study the alterations in genetic expression in the right ventricle due to pressure and volume overload.
METHODS: Experimental right ventricular failure was induced in pigs (n = 11) through 2 h of pulmonary banding. The pigs were randomized to either treatment with a modified Glenn shunt and pulmonary banding (n = 6) or solely pulmonary banding (n = 5) as a control group. Haemodynamic measurements, blood samples and right ventricular biopsies for genetic analysis were sampled at baseline, at right ventricular failure (i.e. 2 h of pulmonary banding) and 1 h post-right ventricular failure in both groups.
RESULTS: Right atrial pressure increased from 10 mmHg (9.0-12) to 18 mmHg (16-22) (P < 0.01) and the right ventricular pressure from 31 mmHg (26-35) to 57 mmHg (49-61) (P < 0.01) after pulmonary banding. Subsequent treatment with the modified Glenn shunt resulted in a decrease in right atrial pressure to 13 mmHg (11-14) (P = 0.03). In the control group, right atrial pressure was unchanged at 19 mmHg (16-20) (P = 0.18). At right heart failure, there was an up-regulation of genes associated with heart failure, inflammation, angiogenesis, negative regulation of cell death and proliferation.
CONCLUSIONS: Volume exclusion with a modified Glenn shunt during right ventricular failure reduced venous congestion compared with the control group. The state of right heart failure was verified through genetic expressional changes.