介入放射学杂志
介入放射學雜誌
개입방사학잡지
JOURNAL OF INTERVENTIONAL RADIOLOGY
2014年
10期
897-900
,共4页
张志钢%李长永%谭洪文%储国俊%朱玉峰%白元%许旭东%熊文峰%黄新苗%赵仙先%吴弘%秦永文
張誌鋼%李長永%譚洪文%儲國俊%硃玉峰%白元%許旭東%熊文峰%黃新苗%趙仙先%吳弘%秦永文
장지강%리장영%담홍문%저국준%주옥봉%백원%허욱동%웅문봉%황신묘%조선선%오홍%진영문
心房纤颤%左心耳%封堵器%犬
心房纖顫%左心耳%封堵器%犬
심방섬전%좌심이%봉도기%견
atrial fibrillation%left atrial appendage%occluder%dog
目的：验证一种建立实验犬经皮左心耳封堵途径方法的安全性及可行性。方法12只实验犬房间隔穿刺后在不同体位左房造影后测量左心耳颈部直径，沿导丝送入输送封堵器的鞘管至左房中部，沿鞘管送入猪尾导管至左心耳内，沿猪尾导管推送输送长鞘进入左心耳内，退出猪尾导管经长鞘管造影观察鞘管在左心耳内的位置。术后1h行心电图及经胸超声检查，即刻处死5只实验犬，取心脏观察房间隔穿刺位置、左房及左心耳内损伤情况。其余犬术后1h及2周经胸超声心动图检查，随访1个月。结果术中1只犬因心脏压塞死亡。8只犬在RAO30°＋ CRA20°造影可以清楚显示左心耳形态，3只在RAO30°，1只在RAO30°＋CAU20°清楚显示左心耳形态，测量左心耳颈部直径为（13.6±5.2）mm，输送长鞘管均成功送入左心耳远端，无气栓、血栓、心脏压塞，2只穿刺点血肿，经加压包扎血肿吸收。术后即刻处死犬取心脏观察心包腔内未见血性液体，1只犬左房后壁轻度血肿，2只左心耳上缘内膜轻度损伤可见血肿，手术操作时间（58±12）min，透视时间（10.1±2.5）min。其余犬术后及2周经胸超声随访无心包积液。随访1个月无猝死、卒中、感染。结论应用本方法可安全有效的建立输送左心耳封堵器至左心耳内的途径。
目的：驗證一種建立實驗犬經皮左心耳封堵途徑方法的安全性及可行性。方法12隻實驗犬房間隔穿刺後在不同體位左房造影後測量左心耳頸部直徑，沿導絲送入輸送封堵器的鞘管至左房中部，沿鞘管送入豬尾導管至左心耳內，沿豬尾導管推送輸送長鞘進入左心耳內，退齣豬尾導管經長鞘管造影觀察鞘管在左心耳內的位置。術後1h行心電圖及經胸超聲檢查，即刻處死5隻實驗犬，取心髒觀察房間隔穿刺位置、左房及左心耳內損傷情況。其餘犬術後1h及2週經胸超聲心動圖檢查，隨訪1箇月。結果術中1隻犬因心髒壓塞死亡。8隻犬在RAO30°＋ CRA20°造影可以清楚顯示左心耳形態，3隻在RAO30°，1隻在RAO30°＋CAU20°清楚顯示左心耳形態，測量左心耳頸部直徑為（13.6±5.2）mm，輸送長鞘管均成功送入左心耳遠耑，無氣栓、血栓、心髒壓塞，2隻穿刺點血腫，經加壓包扎血腫吸收。術後即刻處死犬取心髒觀察心包腔內未見血性液體，1隻犬左房後壁輕度血腫，2隻左心耳上緣內膜輕度損傷可見血腫，手術操作時間（58±12）min，透視時間（10.1±2.5）min。其餘犬術後及2週經胸超聲隨訪無心包積液。隨訪1箇月無猝死、卒中、感染。結論應用本方法可安全有效的建立輸送左心耳封堵器至左心耳內的途徑。
목적：험증일충건립실험견경피좌심이봉도도경방법적안전성급가행성。방법12지실험견방간격천자후재불동체위좌방조영후측량좌심이경부직경，연도사송입수송봉도기적초관지좌방중부，연초관송입저미도관지좌심이내，연저미도관추송수송장초진입좌심이내，퇴출저미도관경장초관조영관찰초관재좌심이내적위치。술후1h행심전도급경흉초성검사，즉각처사5지실험견，취심장관찰방간격천자위치、좌방급좌심이내손상정황。기여견술후1h급2주경흉초성심동도검사，수방1개월。결과술중1지견인심장압새사망。8지견재RAO30°＋ CRA20°조영가이청초현시좌심이형태，3지재RAO30°，1지재RAO30°＋CAU20°청초현시좌심이형태，측량좌심이경부직경위（13.6±5.2）mm，수송장초관균성공송입좌심이원단，무기전、혈전、심장압새，2지천자점혈종，경가압포찰혈종흡수。술후즉각처사견취심장관찰심포강내미견혈성액체，1지견좌방후벽경도혈종，2지좌심이상연내막경도손상가견혈종，수술조작시간（58±12）min，투시시간（10.1±2.5）min。기여견술후급2주경흉초성수방무심포적액。수방1개월무졸사、졸중、감염。결론응용본방법가안전유효적건립수송좌심이봉도기지좌심이내적도경。
Objective To evaluate the feasibility and safety of a delivery pathway for the performance of percutaneous left atrial appendage (LAA) occlusion in experimental canine models. Methods Transseptal puncture was performed via femoral vein approach under fluoroscopic and angiographic guidance in 12 experimental dogs. A pigtail catheter was advanced into the left atrium (LA), which was followed by LA angiography. The diameters of the neck of LAA were measured on LAA angiogram obtained in appropriate projection. After the delivery sheath was advanced along the wire into LA, a pigtail catheter was inserted into the ostium of the LAA and the sheath was then advanced over the pigtail into the LAA. LAA angiography was then performed through the delivery sheath to confirm the position of the delivery sheath. One hour after the procedure both electrocardiography (ECG) and transthoracic echocardiography (TTE) were carried out in five dogs to check the results, immediately after which the five dogs were sacrificed to macroscopically observe the damages of the puncture site of inter-atrial septum as well as inside the LA and LAA. One hour and 2 weeks after the procedure TTE was conducted in the remaining 7 dogs and these dogs were followed up for one month. Results One dog died of pericardial tamponade during the operation. In 8 dogs the LAA was clearly displayed in the projection position of right anterior oblique (RAO) 30°/cranial (CRA) 20°,while in 3 dogs the LAA was well visualized in the projection position of RAO 30° , and in one dog in the projection position of RAO 30°/caudal (CAU) 20°. The diameter of LAA neck was (13.6 ± 5.2) mm. The delivery sheath was safely advanced into the LAA along the pigtail catheter in all dogs, and no air embolism, thrombus or pericardial tamponade occurred. Hematoma at puncture point of groin occurred in 2 dogs, which was absorbed through pressure dressing. Macroscopic examination of the heart performed immediately after the operation showed that no bloody pericardial effusion was found, and mild hematoma at posterior wall of LA was seen in one dog and mild damage of the upper-margin intima of LAA was noted in 2 dogs. The mean fluoroscopy time was (10.1 ± 2.5) minutes and the mean operation time was (58 ± 12) minutes. TEE showed no pericardial effusion 2 weeks after the procedure. During the follow-up period of one month no sudden death, stroke or infection occurred. Conclusion This method of placing the delivery sheath into the LAA is clinically safe and effective, and it can reliably establish a pathway to advance the LAA occluder into LAA.
