经导管建立大动物急性主动脉瓣关闭不全模型的实验研究  

Transcatheter establishment of an animal model with acute aortic valve regurgitation: an experimental study

作　　者：陈翔[1] 王飞宇[2] 谭洪文 白元[2] 朱玉峰[2] 张志钢[2] 张本[3] 赵仙先[2] 秦永文[2] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心血管内科,上海200023 [2]第二军医大学长海医院心血管内科 [3]第二军医大学长海医院心胸外科

出　　处：《介入放射学杂志》2014年第7期615-618,共4页Journal of Interventional Radiology

基　　金：中国博士后科学基金面上资助(2014M551330)

摘　　要：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。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 ao

关 键 词：经导管 主动脉瓣关闭不全 主动脉瓣返流 动物模型 

分 类 号：R-332[医药卫生] R541