一种建立实验犬经皮左心耳封堵途径的方法  

Percutaneous occlusion of left atrial appendage in experimental canine models:the establishment of the delivery pathway

作　　者：张志钢[1,2] 李长永[1] 谭洪文 储国俊 朱玉峰[1] 白元[1] 许旭东[1] 熊文峰[3] 黄新苗[1] 赵仙先[1] 吴弘[1] 秦永文[1] 

机构地区：[1]第二军医大学长海医院心内科,上海200433 [2]南京军区福州总医院心内科 [3]第二军医大学长海医院超声科,上海200433

出　　处：《介入放射学杂志》2014年第10期897-900,共4页Journal of Interventional Radiology

基　　金：上海市自然科学基金BZR1409500;上海市卫生局级科研课题重点课题

摘　　要：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1 h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1 h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。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 blo

关 键 词：心房纤颤 左心耳 封堵器 犬 

分 类 号：R541.7[医药卫生—心血管疾病]