| 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。 目的 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0.8 cm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。 |
| 关键词: 左心耳 心房颤动 封堵器 动物实验 犬科 |
| DOI：10.3724/SP.J.1008.2015.01045 |
| 投稿时间：2015-06-10修订日期：2015-07-27 |
| 基金项目: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). |
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| Transthoracic left atrial appendage reverse occlusion: instrument development and in vitro animal experiment |
| CHU Guo-jun1Δ,ZHU Yu-feng1Δ,HUANG Xin-miao1,WU Hong1*,ZHANG Wei1,KAN Tong1,TAN Hong-wen2,ZHAO Xian-xian1,QIN Yong-wen1* |
(1. Department of Cardiovasology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
2. Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang 550002, Guizhou, China
△Co-first authors.
*Corresponding authors.) |
| Abstract: |
| 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 1/3 left 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 1/3 left atrial appendage. The delivery system comprised 9F delivery 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 0.8 cm 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 1/3 axis of left atrial appendage outside under direct vision, and 9F sheath 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 1/3 long axis of left atrial appendage outside, and the purse-string suture should focus on this point. The puncture points located at the center of the left atrial appendage opening after removing the occluder postoperatively. Only 1 case failed because of low puncture point and unsuitable location of the occluder. Conclusion The glass-shaped transthoracic reverse occluder is well-designed and matched the anatomy of left the atrial appendage in experimental canine. The occluding effects are exact and meet the requirements of animal experiments in vivo. |
| Key words: left atrial appendage atrial fibrillation occluders animal experiment canidae |
