J.Jpn. Surg. Soc.. 58(9): 1340-1364, 1957

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EXPERIMENTAL STUDIES ON INTRACARDIAC SURGERY UNDER DIRECT VISION, WITH SPECIAL EVALUATION OF " RETROGRADE CORONARY PERFUSION TECHNIQUE "

The extracorporeal circulation techniques, to which our coronary perfusion technique belongs, may be of little practical use so far as it concerns to treat heart failures complicated by aortic insufficiency. In these techniques the perfused blood regorges usually through the imcompetent aortic valve into the left ventricle.
An open attack into the origin of ascending aorta on a patient with aortic valve disease or aortic septal defect may reasonably be the cause of coronary air embolism, stop of coronary blood flow or ventricular fibrillation.
The author may herewith introduce "a new retrograde coronary perfusion technique", which established rationale of an intra-aortic approach with no danger of coronary air embolism, myocardial disorders etc.
1) Ventricular fibrillation could easily be avoided in various perfusion quantities, i. e., 1.0~7.0 cc/kg/min.. The heart action remained almost regularly, powerfully and continued well at least for about 30 min., when the perfusion was conditioned under moderate quantity, i. e., 3.0 cc/kg/min..
2) The high potentiated pressure of the coronary sinus over 100 cmH₂O, or the increased blood quantity over 5.0 cc/kg/min. induced myocardial bleeding.
3) O₂ consumption showed the largest value in the perfusion quantity of 5.0 cc/kg/min., but it amounted only 1/3 of that in the ordinary coronary perfusion. Electrocardiographic tracings revealed prolongation of PQ and QT, complete heart block, low or high take off of ST and inversion or elevation of T wave etc.
4) Retrograde blood flows throughout the whole myocardium usually with certain differences among its distributions.
A formula was presented by the author incident to the circulatory dynamics of retrograde perfused blood in the myocardium.
5) Employing this retrograde perfusion technique combined with the head cooling or the brain perfusion method, the author achieved success to present some survivals of dogs, undergone an incision on the aortic origin, even under cessation of general circulation for about thirty minutes or longer.
(author's abstract)

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