经胸左心耳反向封堵术的器械研制和体外动物实验  

Transthoracic left atrial appendage reverse occlusion:instrument development and in vitro animal experiment

作　　者：储国俊 朱玉峰[1] 黄新苗[1] 吴弘[1] 章伟[1] 阚通 谭洪文 赵仙先[1] 秦永文[1] 

机构地区：[1]第二军医大学长海医院心血管内科,上海200433 [2]贵州省人民医院心内科,贵阳550002

出　　处：《第二军医大学学报》2015年第10期1045-1050,共6页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金(81170150);上海市自然科学基金(132R1409500);第二军医大学2014年度博士创新基金(201402)~~

摘　　要：目的设计和制作"酒杯状"经胸反向封堵左心耳封堵器及输送系统,并用体外封堵实验评价其经胸反向封堵左心耳的可行性,为后续动物实验奠定基础。方法选取健康杂种犬离体心脏标本,测量获取封堵器设计需要的参数,包括左心耳开口长径、短径及周长,左心耳上中1/3处厚度,左心耳开口边缘距离左上、下肺静脉及左房室瓣的最短距离。采用镍钛合金丝编织"酒杯状"左心耳封堵器,心耳开口平均直径及上中1/3处厚度分别用于指导设计封堵器心耳开口盘面直径及腰高。输送系统包括9F输送鞘及匹配的扩张鞘、预载鞘及推送杆。输送鞘上有刻度可把握进入左心耳深度,扩张鞘头端为平滑过渡设计,插入输送鞘后头端仅露出约0.8cm以防损伤心脏内部结构。取10例健康杂种犬离体心脏标本,直视下在左心耳外上中1/3中央处穿刺,使用带刻度的9F鞘管及该封堵器完成体外封堵实验,观察封堵器位置和封堵效果。结果 10例犬心脏标本中9例成功完成封堵,封堵器释放后位置良好,心耳口侧盘片进入心耳口内少许,左心耳开口呈过度撑开状态,不影响肺静脉血液回流和左房室瓣功能。穿刺点位于左心耳外长轴上中1/3处比较理想,荷包应该围绕这一点来制作,术后撤去封堵器见穿刺点位置正对于左心耳开口中央。1例因穿刺点偏低,封堵器位置不佳,封堵失败。结论 "酒杯状"经胸左心耳反向封堵器设计合理,与实验犬左心耳解剖形态匹配,封堵效果确切,符合进行后续动物在体实验的要求。Objective To design and prepare a glass-shaped transthoracic left atrial appendage（LAA）reverse occluder and delivery system,and to evaluate the feasibility of transthoracic left atrial appendage reverse occlusion by in vitro reverse occlusion experiment.Methods We used fresh canine heart specimens and measured the anatomical parameters,including the long diameter,short diameter and perimeter of atrial appendage opening,the thickness of upper 1/3left atrial appendage,the shortest distances from the edge of the opening of the atrial appendage to the left superior pulmonary vein,the left inferior pulmonary vein,and the mitral valve.A new glass-shaped left atrial appendage occluder was designed using nitinol wire,and the appendage occluder opening disk diameter and waist height were designed according to the average diameter of the opening of the atrial appendage and the thickness of upper 1/3left atrial appendage.The delivery system comprised 9Fdelivery sheath,expansion sheath,preload sheath and a pushing cable.Delivery sheath was scaled which can be used to control the depth into the left atrial appendage,and expansion sheath head end had smooth transition shape which exposed only about 0.8cm when inserted into the delivery sheath to prevent damage internal of tissue of heart.Ten isolated dog hearts were punctured at the center of the upper 1/3axis of left atrial appendage outside under direct vision,and 9Fsheath with scale was used to complete in vitro experiment of occlusion.The location and effect of the occluder were observed.Results Nine of the 10 heart specimens successfully underwent the occluding tests in vitro.It was showed that the occluder was well located,with the disc of the opening of left atrial appendage porting into the opening a little and the opening in an overdistraction state,and there was no influence on blood flow of pulmonary vein or function of the mitral valve.The ideal point of puncture was at the upper 1/3long axis of left atrial appendage outside,and the purse-string suture should f

关 键 词：左心耳 心房颤动 封堵器 动物实验 犬科 

分 类 号：R541.75[医药卫生—心血管疾病]