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The Journal of Thoracic and Cardiovascular Surgery, Vol 70, 869-879, Copyright © 1975 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

The significance of coronary arterial stenosis during cardiopulmonary bypass

RM Engelman, FC Spencer, AD Boyd and R Chandra

Myocardial infarction may develop during an uneventful open-heart operation. In order to better understand this complication, we undertook an experimental study. The left circumflex coronary artery of 20 dogs was narrowed to 50 per cent of its area by a metal screw clamp to produce a localized coronary stenosis. Regional myocardial perfusion in the distribution of both the stenotic circumflex and normal left anterior descending (LAD) coronary arteries was measured by injection of a radioactive-labeled microsphere (15 +/- 5 mu). Circumflex coronary artery flow was measured with an electromagnetic flow probe. An epicardial electrogram was recorded in the distribution of the left circumflex. Measurements of regional myocardial perfusion, circumflex flow, and the epicardial electrogram were performed in each animal during the control (prebypass) state and during cardiopulmonary bypass with a beating and fibrillating ventricle. Half the animals had cardiopulmonary bypass performed at 50 mm. Hg perfusion pressure and half at 100 mm. Hg. The animals were put to death at the end of the study, and the hearts were sectioned, weighed, and counted. A cast was made of the stenotic circumflex coronary artery, the degree of stenosis is measured, and the per cent area stenosis calculated. The study showed that the effect of a 50 per cent coronary stenosis in reducing distal flow is apparent only during cardiopulmonary bypass at reduced pressure. The mechanism whereby a myocardial infarction develops during cardiopulmonary bypass could evolve from the development of a "critical" stenosis out of a mild-moderate one at a reduced perfusion pressure during cardiopulmonary bypass.


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G. Noera, C. Massini, R. Lodi, and G. Baggio
Normothermic blood cardioplegia reperfusion plus nifedipine after cardioplegic arrest: experimental study with a new delivery set
Perfusion, July 1, 1987; 2(3): 185 - 194.
[Abstract] [PDF]


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Copyright © 1975 by The American Association for Thoracic Surgery.