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

发布时间：2018-06-07 18:02

本文选题：经导管 + 主动脉瓣关闭不全　；参考：《介入放射学杂志》2014年07期

【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。
[Abstract]:Objective to study the feasibility and effectiveness of acute aortic valve insufficiency model by using catheter intervention to destroy aortic valve in large animals. Methods 8 healthy goats were selected. The left ventricular apex was exposed through a small incision of open chest, and the orbit was established. Under the guidance of X ray, the sheath was transferred to the aortic valve along the hard wire to transport the sheath to the aortic valve, and the sheath was withdrawn from the inner sheath. The 10 F sheathing tube was fed into the aortic valve with a lumbar diameter of 10 mm. The 10 F sheathing tube was withdrawn to the left ventricular retaining occluder on the aortic valve. The model of acute aortic insufficiency was established by rapid retraction of ventricular occluder to the left ventricle to cause aortic valve damage. The degree of aortic valve regurgitation was determined by transthoracic echocardiography immediately after operation. Results the model of immediate aortic regurgitation was established successfully in 8 experimental sheep. Two of them died on the spot due to aortic regurgitation flow, largely acute left ventricular failure. Postoperative anatomical observation showed aortic valve damage. Among the 6 surviving sheep, 5 were confirmed as moderate aortic regurgitation and 1 as a small amount of regurgitation by superior aortic valve angiography and echocardiography. One moderate regurgitation experiment died of heart failure on the 7th and 15th day after operation, and the remaining 4 sheep survived for more than 3 months. After 3 months, reexamination of ultrasound revealed mild to moderate aortic valve regurgitation. Conclusion it is feasible to establish acute aortic regurgitation aortic valve insufficiency model by transcatheter closure with transcatheter ventricular septal defect occluder via apical approach, simple operation, good repeatability, controllable degree of aortic regurgitation and reliable effect.
【作者单位】：复旦大学附属中山医院心血管内科;第二军医大学长海医院心血管内科;第二军医大学长海医院心胸外科;
【基金】：中国博士后科学基金面上资助(2014M551330)
【分类号】：R-332;R541

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