CAJ | 학술논문

目的：探讨通过经导管介入的方法破坏大动物的主动脉瓣，建立急性主动脉瓣膜关闭不全模型的可行性和有效性。方法选取健康山羊8只，侧开胸小切口暴露心尖，穿刺左心室心尖，建立轨道， X 线引导下沿加硬导丝送入10 F 输送鞘管至主动脉瓣上，退出内鞘。沿10 F 输送鞘管送入腰部直径为10 mm 的肌部室间隔缺损（室缺）封堵器至主动脉瓣上，回撤10 F 输送鞘管至左心室保留封堵器在主动脉瓣上。快速回拉室缺封堵器至左心室以造成主动脉瓣膜破坏，建立急性主动脉瓣关闭不全的模型。手术后即刻主动脉瓣上造影经胸心脏超声确定主动脉瓣返流程度。结果8只实验羊即时主动脉瓣返流模型均成功建立。其中2只因主动脉瓣返流量过大致急性左心衰竭当场死亡。术后解剖肉眼观察可见主动脉瓣叶受损。存活的6只羊经术后主动脉瓣上造影及心脏超声检查证实其中5只为中量主动脉瓣返流，1只为少量返流。术后7、15 d 分别有1只中等量返流实验羊死于心力衰竭，余4只羊存活超过3个月。3个月后复查超声提示主动脉瓣轻至中度返流。结论经心尖途径经导管室缺封堵器回拉法制作大动物急性主动脉瓣返流主动脉瓣关闭不全模型可行，操作简单、重复性好，主动脉瓣反流程度可控，效果可靠。
목적：탐토통과경도관개입적방법파배대동물적주동맥판，건립급성주동맥판막관폐불전모형적가행성화유효성。방법선취건강산양8지，측개흉소절구폭로심첨，천자좌심실심첨，건립궤도， X 선인도하연가경도사송입10 F 수송초관지주동맥판상，퇴출내초。연10 F 수송초관송입요부직경위10 mm 적기부실간격결손（실결）봉도기지주동맥판상，회철10 F 수송초관지좌심실보류봉도기재주동맥판상。쾌속회랍실결봉도기지좌심실이조성주동맥판막파배，건립급성주동맥판관폐불전적모형。수술후즉각주동맥판상조영경흉심장초성학정주동맥판반류정도。결과8지실험양즉시주동맥판반류모형균성공건립。기중2지인주동맥판반류량과대치급성좌심쇠갈당장사망。술후해부육안관찰가견주동맥판협수손。존활적6지양경술후주동맥판상조영급심장초성검사증실기중5지위중량주동맥판반류，1지위소량반류。술후7、15 d 분별유1지중등량반류실험양사우심력쇠갈，여4지양존활초과3개월。3개월후복사초성제시주동맥판경지중도반류。결론경심첨도경경도관실결봉도기회랍법제작대동물급성주동맥판반류주동맥판관폐불전모형가행，조작간단、중복성호，주동맥판반류정도가공，효과가고。
Objective To explore the feasibility and effectiveness of interventional transcatheter destruction of the aortic valve to establish an animal model with acute aortic valve regurgitation. Methods Eight healthy goats were used for this study. A limited sternotomy approach was used to access the apex of the heart. Puncturing of the apex of the heart was performed to establish a wire track, then, under fluoroscopic guidance a 10 F sheath was inserted along this track of hard wire until to the ascending aorta above the aortic valve. The internal sheath was removed. Via the 10 F sheath a 10 mm occluder of ventricular septal defect (VSD) was introduced into the ascending aorta above the aortic valve. The sheath was pulled back to the left ventricle, while the occluder remained in the ascending aorta above the aortic valve. Then the occluder was quickly pulled back into the left ventricle in order to make some certain damage to the aortic valve. And an acute aortic valve regurgitation model was thus established. Angiography of ascending aorta above the aortic Among the 8 animals, two died of acute left ventricular failure on the spot due to excessive regurgitation blood flow after the operation. Macroscopically, damage of the aortic valve was seen. In the six survivors, angiography of ascending aorta above the aortic valve and Doppler echocardiography showed that moderate degree of regurgitation was detected in 5 and small amount of regurgitation in one. Two experimental goats with moderate degree of regurgitation died of heart failure separately at seven days and fifteen days after the operation. The remaining four experimental goats survived for more than three months. Follow- up checkups with echocardiography suggested the presence of mild- moderate degree of regurgitation. Conclusion Acute aortic valve regurgitation model in experimental goats can be established through transapical transcatheter damage of aortic valve by quickly pulling back a VSD occluder which has been placed in the ascending aorta above the aortic valve. This method is clinically feasible, technically simple and repeatable, the result is reliable, and the degree of regurgitation is controllable.