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Treatment of severe cardiogenic shock by diastolic augmentation after ligation and division of the left circumflex coronary artery in dogs

1966; Elsevier BV; Volume: 51; Issue: 6 Linguagem: Inglês

10.1016/s0022-5223(19)43471-5

1097-685X

David S. Goldfarb, C Conti, B. Greg Brown, Vincent L. Gott,

Cardiac Arrhythmias and Treatments

Summary Fifteen dogs underwent ligation and division of the left circumflex coronary artery and received no treatment. Of these, 13 (86.6 per cent) died within 21 minutes after ligation. Diastolic augmentation was applied for a maximum of 2 hours immediately following ligation and division of the left circumflex coronary artery in 15 other dogs. Of these, 13 (86.6 per cent) survived at least 1 hour and 45 min. after ligation. Such clear separation of survival between these 2 groups demonstrated the effectiveness of diastolic augmentation in the treatment of severe cardiogenic shock and left ventricular failure. S-T segment elevation occurred shortly following coronary arterial ligation in 12 dogs that received diastolic augmentation. In 9 (75 per cent) of these dogs, the S-T segments returned to or toward the isoelectric base line from 15 to 120 min. after ligation. The S-T segments in 8 of 12 experiments then became elevated or depressed following the discontinuation of diastolic augmentation. Such evidence thus supports the concept that raising the arterial pressure during diastole reduced myocardial ischemia. Physiologic mechanisms have been proposed in order to explain the better survival of those animals which received diastolic augmentation. Briefly, it is believed that diastolic augmentation enabled improved performance from ischemic left ventricular myocardium by increasing the coronary perfusion and decreasing the energy requirement in this myocardium. The authors wish to thank Mr. Floyd S. Barnett for his technical assistance.