经静脉注射造影剂超声心肌微泡造影观测钬激光及活检针心肌再血管化

目的：研究钬激光和True-cut活检针心肌再血管化的方法,机制及近期效果。方法：经静脉注射造影剂,在心仙缺血前后和再血管化后三个不同时期对犬时期对犬进行心肌超声微泡造影。研究钛激光和True-cut活检针心肌再血管化的机制及观察近期效果。结果：部分结扎犬冠状动脉前降支后,缺血区超声微泡密度明显降低.分别用两种方法再血管化后,缺血区超声微泡密度较缺血时明显增加（P＜0．01）,接近缺血前的微泡密度,再血管化区超声微泡较其它部位提前显影。结论：钬激光和True-cut活检针再血管化均可使缺血心肌灌注即刻改善;再血管化心肌隧道可在收缩期灌注心肌。     

EXPERIMENTAL STUDY OF HOMIUM: YAG LASER TRANSMYOCARDIAL REVASCULARIZATION IN ACUTE ISCHEMIC SET TINGS WITH MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY

ＩＮＴＲＯＤＵＣＴＩＯＮ　　Ｓｅｎ( 1)ｄｅｍｏｎｓｔｒａｔｅｄｉｎ 1965ｔｈａｔｃａｒｄｉａｃａｃｕｐｕｎｃｔｕｒｅｌｅｄｔｏｉｍｐｒｏｖｅｄｐｅｒｆｕｓｉｏｎｏｆｔｈｅｍｙｏｃａｒｄｉｕｍａｎｄｓｕｒｖｉｖａｌｉｎｄｏｇｓａｆｔｅｒｔｈｅａｎｔｅｒｉｏｒｄｅｓｃｅｎｄｉｎｇｃｏｒｏｎａｒｙａｒｔｅｒｙｈａｄｂｅｅｎｌｉｇａｔｅｄ .Ｈｏｗｅｖｅｒ ,Ｐｉｆａｒｅ( 2 )ｆｏｕｎｄｔｈａｔｓｕｃｈｃｈａｎｎｅｌｓｄｉｄｎｏｔｒｅｍａｉｎｐａｔｅｎｔｄｕｅｔｏｅａｒｌｙｆｉｂｒｏｓｉｓ.Ｉｎ 1982 ,Ｍｉｒｈ…     

EXPERIMENTAL STUDY OF HOMIUM： YAG LASER TRANSMYOCARDIAL REVASCULARIZATION IN ACUTE ISCHEMIC SETFINGS WITH MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY

OBJECTIVE: To study the mechanism and effects of blood perfusion to the acute ischemic region of myocardium through Ho-YAG laser channels with myocardial contrast echocardiography. METHODS: To produce the model of acute myocardial ischemia, we partially ligated the left anterior decending (LAD) coronary artery of canine hearts between 1st. and 2nd. diagonal branches and then performed transmyocardial revascularization in this region with Ho - YAG laser. Myocardial contrast echocardiography was made with a new generation of ultrasound contrast agent and second harmonic imaging of this region before, after ischemia and after laser revascularization. Pictures were taken with "R" wave trigger skill. RESULTS: Acoustic density determing in the ischemia region (anterior wall) with MCE (myocardial contrast echocardiography) was obviously decreased (5.40 +/- 1.81) after the LAD was ligated,as compared with before (11.69 +/- 1.61, P < 0.01). It was increased remarkably after transmyocardial laser revascularization (TMLR) (11.2 +/- 2.01, P < 0.01) as compared with that when ischemia and approximated to that before ischemia (P > 0.05). There were no differences in acoustic density in the lateral wall (as control) among these comprehensive three periods (P > 0.05). Contrast in the laser region developed one cardiac cycle ahead of that in the non-ischemic normal region. CONCLUSION: Acute ischemic myocardium can be perfused by oxygenated blood from the left ventricle through Ho - YAG laser channels. Evidence of blood perfusion through laser channels during systolic phase was detected, and myocardial contrast ultrasonography using intravenous perfluorocarbon-exposed sonicated dextrose albumin may be regarded as a reliable method in the study of transmyocardial revascularization.     

网膜心脏固定术增加缺血心肌激光再血管化的远期疗效

心肌Nd:YAG激光孔道远期均为纤维组织闭塞,采用网膜心脏固定术增加对缺血心肌远期的保护作用。18条杂交犬分为3组:对照组(n=6)、激光心肌再血管化组(n=6)和激光心肌再血管化 网膜心脏固定术组(n=6)。对照组仅结扎左侧冠状动脉前降支的对角支、中间支的第一、二支,及与之相连的左侧回旋支的钝缘支的吻合支,建立动物模型。单纯激光心肌再血管化组:用Nd:YAG激光刀,于左室壁心肌缺血区直接贯穿打孔6～8个,孔间距10mm。网膜心脏固定术组在激光心肌再血管化后,行大网膜经皮下遂道移植于心脏表面。术后4周行放射性同位素~(86)Rb摄取分数,示踪剂检查和心肌组织学活捡。结果显示网膜心脏固定术缺血心肌区远期的放射性同位素~(86)Rb摄取分数增加,网膜—心肌测支血液循环建立。     

血管再生治疗对急性心肌梗塞犬心脏功能的影响

目的 :采用超声心动图心功能测定、组织多普勒显像和血流多普勒频谱技术 ,评价心肌内控制释放碱性成纤维细胞生长因子 (bFGF)血管再生治疗对急性心肌梗塞 (AMI)犬心脏收缩与舒张功能的影响。方法 :18只成年健康杂种犬于开胸后结扎左前降支 (LAD) ,制作AMI模型。动物平均分为 3组 ,单纯心肌梗塞 (MI)组 ,直接关胸 ;激光心肌血运重建 (TMR)组 ,于AMI 30min后行透壁心肌打孔 ;bFGF组 ,于AMI 30min后行非透壁心肌打孔 ,并随后向孔道内注射含有bFGF的纤维蛋白胶 (FG) ,以封闭激光孔道。 8周后行超声心动图检查 ,以评价心脏收缩与舒张功能。结果 :MI组与TMR组于术后 2 2d和 34d各有一只死亡 ,bFGF组无死亡。bFGF组的左心室射血分数 (EF)、每搏出量 (SV)和心输出量 (CO)均明显高于MI组与TMR组 (P均 <0 .0 5 )。bFGF组的左心室面积变化分数 (FAC)明显高于MI组 ,室壁运动指数 (WMI)明显低于MI组 ,但与TMR组相比均无明显差异。尽管采用TMR和bFGF干预后有改善舒张功能的趋势 ,但采用二尖瓣口血流频谱和二尖瓣瓣环的组织多普勒血流显像两种方法测得 3组的E A比值却均无明显差异。结论 :使用FG在心肌内控制释放bFGF进行血管再生治疗安全可行 ,能显著改善急性心肌梗塞犬的收缩功能 ,但对梗塞心脏的舒张功能改善不明显?     

Real-time myocardial contrast echocardiography can predict functional recovery and left ventricular remodeling after revascularization in patients with ischemic heart disease

Background Previous studies showed that preservation of microvascular integrity after myocardial ischemia was associated with myocardial viability. Real-time myocardial contrast echocardiography (RT-MCE) is a promising modality for non-invasive evaluation of microcirculation perfusion. Thus, it provides a unique tool to detect myocardial viability. We sought in this study to investigate the role of RT-MCE in predicting left ventricular (LV) functional recovery and remodeling after revascularization in patients with ischemic heart disease.Methods Thirty-one patients with ischemic heart disease and resting regional LV dysfunction were included. LV volume, global and regional function were evaluated by echocardiography before and 6&#8722;9 months after revascularization. RT-MCE was performed before revascularization using low mechanical index power modulation imaging. Myocardial contrast opacification of dysfunctional segments was scored on a 3-point scale and mean contrast score in dysfunctional segments was calculated. Patients were divided into 2 groups according to mean contrast score in dysfunctional segments: group A, patients with mean contrast score ≥0.5 (n=19); group B, patients with mean contrast score &lt; 0.5 (n=12). Results Wall motion improvement was found to be 94.5%, 45.5% and 16.1% respectively (P&lt;0.01) in homogenous, patchy and absent contrast opacification segments. At baseline, there was no significant difference in LV volume and global function between the two groups. After revascularization, group B had significantly larger LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV), lower LV ejection fraction (LVEF) and higher wall motion score index (WMSI) than those of group A (all P&lt;0.05). Revascularization was followed by significant improvement of LV volume and recovery of global LV function in group A (all P&lt;0.01); however, in group B, after revascularization, deterioration of LVEDV (P&lt;0.05) was observed, moreover LVESV, WMSI and LVEF did not change significantly.Conclusions The maintenance of myocardial microcirculation detected by RT-MCE can predict functional recovery and LV remodeling after revascularization in patients with ischemic heart disease, which might be helpful in clinical decision-making and risk stratification.     

1000 W CO_2激光心肌血运重建术对心肌ATP含量影响的实验研究

目的 探讨1000WCO2 激光心肌血运重建术 (TMLR)对缺血心肌血流灌注的影响。 方法 制备绵羊急性心肌缺血模型 ,行1000WCO2 激光TMLR ,并测量TMLR前后心肌ATP的含量。结果 绵羊急性缺血心肌经TMLR后心肌组织ATP含量明显增加 (P<0.01) ,心肌收缩力明显增强。 结论 TMLR能有效改善心肌血流灌注 ,恢复心肌活性 ,从而提高心功能。     

经皮激光心肌血运重建术治疗心肌缺血机制的实验研究

目的　探讨经皮激光心肌血运重建术 (PMR)治疗心肌缺血的机制。方法　取体重 14～18kg的雄性杂种健康犬 10条 ,随机分为PMR组和对照组 ,每组 5条。对两组犬均以不完全结扎冠状动脉 (冠脉 )左前降支的方法复制慢性心肌缺血模型。PMR组在冠脉结扎术后 2周采用Ho :YAG激光系统在缺血心壁施行PMR ,每条犬平均打孔 (15± 3)个。PMR组在冠脉结扎前和PMR后 1、4、12周 ,对照组在冠脉结扎前、冠脉结扎后 3、6和 14周 ,以心肌核素显像检查心肌灌注状况 ,以超声心动图测量左室射血分数 (LVEF)。PMR组在 1、4周检测结束后各处死 1条犬 ,12周检测结束后处死 3条犬 ;对照组在 14周检测结束后处死全部 5条犬。取犬心肌组织作形态学观察及血管计数。PMR术后 2 4h病理标本取自PMR预实验犬。结果　 (1)心肌灌注积分 :PMR组冠脉结扎前为 3 2± 0 6 ,PMR后 12周为 0 3± 0 2 ;对照组冠脉结扎前为 3 1± 0 5 ,结扎后 14周为 1 2± 0 3。两组下降幅度的差异有显著意义 (P <0 0 5 )。 (2 )LVEF :PMR组冠脉结扎前为 4 2 6± 6 5 ,PMR后 12周为 5 5 8± 7 6 (P <0 0 5 ) ;对照组冠脉结扎前为 4 3 2± 8 7,结扎后 14周为 4 5 2± 6 3。两组增加幅度的差异有显著意义 (P <0 0 5 )。 (3)PMR犬心肌PMR区域每视野微血管     

Morphological and functional study of ischemic left ventricle after laser transmural revascularization

Ｍｏｒｐｈｏｌｏｇｉｃａｌａｎｄｆｕｎｃｔｉｏｎａｌｓｔｕｄｙｏｆｉｓｃｈｅｍｉｃｌｅｆｔｖｅｎｔｒｉｃｌｅａｆｔｅｒｌａｓｅｒｔｒａｎｓｍｕｒａｌｒｅｖａｓｃｕｌａｒｉｚａｔｉｏｎ￥ＧａｏＦａｂａｏ；ＨｕａｎｇＺｈｉｌａｎ；ＳｕｏＬｉｐｉｎｇ；Ｑｉ...     

两种激光致心肌血管重建的组织学效应

目的；研究两种激光在心肌血管重建术（TMR）中的组织学效应。方法：实验犬随机分为2组：连续波CO2激光组（n=20）及调制Nd：YAG激光组（n=10），2组均经心外膜法行激光打孔，观察激光孔道的组织学改变。结果：CO2激光孔道周围出现明显的碳化带、凝固性坏死层及心肌变性层，经8周的修复，出现不同程度的微循环改建，尤以碳化程度轻的部位为著；而Nd：YAG激光孔道未见碳化物形成，凝固性坏死及心肌变性范围明显减小，术中并发症的发生均较CO2激光减轻。结论：Nd：YAG激光孔道的热损伤程度轻，有利于心肌内微循环改建，以改善心肌供血，且具有术中并发症少等优点。     

高龄高危患者激光心肌血运重建术

采用美国PLC产CO2 激光心脏打孔器 ,对 33例高龄 ( 68～ 78岁 )冠心病心绞痛患者在食管超声心动图(TEE)监测下行心肌打孔 [平均打孔 ( 2 2± 5)个 ]。结果 :无手术死亡 ,术后 4 8h内因急性心肌梗死死亡 2例 ,因心源性休克 (原因不明 )死亡 1例 ;少数患者发生心律失常、精神症状、自发性气胸等并发症。 2 6例患者术后随访 1～ 36月 ,其中 2 3例 ( 88% )患者心绞痛改善或消失 ;1 6例 ( 62 % )单光子发射型计算机断层显示心肌灌注有不同程度改善。提示 :应用高功率CO2 激光对高龄高危冠心病患者行激光打孔心肌血运重建术安全、有效 ;并应加强围术期管理     

过表达HGF促慢性缺血心肌处血管生成的实验研究

目的研究过表达HGF对促进缺血心肌处血管生成作用及对心功能的影响。方法经左胸冠状动脉回旋支放置Ameroid环的方法建立稳定有效的慢性心肌缺血猪模型。随机分为3组(n=6)于缺血心肌处分别注射4×109pfu 200μL AdHGF、4×109pfu 200μL AdNull、200μL Ns。继续饲养4周,检测心脏功能及心肌HGF蛋白表达等。结果全部实验动物成功构建慢性缺血性心脏病模型;治疗后心脏彩超检查示AdHGF组左室前壁缺血区室壁增厚,灌注明显改善,运动增强,LVEDV、LEEF、FS明显增加(P<0.05);AdHGF组心肌组织HGF蛋白较对照组获得较高表达(P<0.05);AdHGF组心肌血管数量及密度均明显高于对照组(P<0.05);Ad-HGF组VIII因子阳性的血管数量明显高于AdNull组(P<0.05)。结论过表达HGF促进慢性缺血心肌处血管生成,增加心肌血流灌注,改善缺血心肌局部微环境,从而改善和保护心功能的作用。     

Histochemical study of transmyocardial laser channels in dogs

目的　了解激光心肌血运重建术时激光对心肌的损伤。方法　在狗心肌上用CO2 激光打孔。术后即刻、两周时于打孔处取材 ,用硝基蓝四唑法作琥珀酸脱氢酶、乳酸脱氢酶组织化学染色。结果　术后即刻 ,孔道及其周围心肌分为五个区。中央为孔道即组织汽化区 ,向外依次为碳化区、酶消失区、酶减少区、酶浓缩区。两周后孔道区被肉芽组织取代 ,周围心肌细胞酶活性正常。结论　激光心肌血运重建术术后即刻 ,孔道周围心肌细胞酶活性由内向外依次呈消失、减少、浓缩改变。术后两周可逆性损伤的心肌细胞酶活性恢复。     

冠状动脉结扎法建立小鼠心肌梗死模型的病理及心功能变化观察

目的：观察小鼠心肌梗死模型的病理与心功能变化。方法：缝扎小鼠冠状动脉左前降支，观察超声心动图变化及心肌组织病理变化情况。结果：小鼠结扎后，左室舒张末、收缩末内径增大；短轴缩短率、射血分数降低。病理切片提示心肌缺血后早期可见大量的炎性细胞浸润及心肌细胞膜不完整表现，晚期可见心肌纤维断裂、心肌细胞坏死。结论：冠状动脉结扎法可成功建立小鼠心肌梗死模型。     

血府逐瘀汤对急性心肌缺血大鼠缺血心肌bFGF、Ang-1表达的影响

目的探讨血府逐瘀汤对急性心肌缺血大鼠缺血心肌bFGF、Ang-1表达的影响。方法采用结扎冠状动脉左前降支的方法复制急性心肌缺血模型,用免疫组化法检测缺血心肌局部碱性成纤维细胞生长因子(bFGF)、血管紧张素1(Ang-1)的表达,观察血府逐瘀汤对心肌缺血大鼠缺血心肌bFGF、Ang-1的影响。结果血府逐瘀汤组bFGF、Ang-1蛋白表达均有明显升高,与模型组比较,差异均有统计学意义(P0.05)。结论血府逐瘀汤能够促进心肌缺血大鼠缺血心肌bFGF、Ang-1的表达,对缺血心肌具有保护作用。     

缺血预处理抑制缺血再灌注所致兔在体心肌细胞凋亡

目的：为探讨缺血预处理对缺血再灌注过程中心肌细胞凋亡的影响。方法：将24只新西兰白兔制成在体心肌缺血／再灌注模型,并随机分成假手术对照组（P组）,缺血／再灌注对照组（IR组）,缺血预处理组（IP组）,结果：IP组心肌梗死面积与缺血面积的比率比IR组显著减少（P＜0．05）;凋亡指数IP组亦比IR组小（P＜0．01）,IR组心肌DNA Ladder形成明显,IP组DNA Ladder模糊不清,结论：缺血预处理对缺血／再灌注损伤中心肌细胞凋亡具有抑制作用。     

CO2激光心肌血管重建术治疗冠心病

目的 总结1999年3月至12月完成的30例激光心肌血管重建术（TMLR）的经验。方法 将30例患者分为冠状动脉路移植术（CABG） TMLR组20例和单纯TMLR组10例。CABG TMLR组采用正中切口,先行CABG,再行TMLR,平均搭桥2.3根,打孔8.2个;TMLR组10例,左前外侧第5助间进胸,行TMLR,平均打孔31.7个。结果 全组无手术死亡,术后1个月内心绞痛均消失,3个月后,CABG TMLR组（1例）5%心绞痛复发,同位素示缺血区消失,TMLR组（7例）70%心绞痛减轻,同位素示缺血区缩小。结论 TMLR能缓解心绞痛,改善生活质量。     

CO_2激光心肌血管重建术治疗冠心病

目的　总结 1999年 3月至 12月完成的 30例激光心肌血管重建术 (TMLR)的经验。方法　将 30例患者分为冠状动脉旁路移植术 (CABG) TMLR组 2 0例和单纯TMLR组 10例。CABG TMLR组采用正中切口 ,先行CABG ,再行TMLR ,平均搭桥 2 .3根 ,打孔 8.2个 ;TMLR组 10例 ,左前外侧第 5肋间进胸 ,行TMLR ,平均打孔 31.7个。结果　全组无手术死亡 ,术后 1个月内心绞痛均消失 ,3个月后 ,CABG TMLR组 (1例 ) 5 %心绞痛复发 ,同位素示缺血区消失 ,TMLR组 (7例 ) 70 %心绞痛减轻 ,同位素示缺血区缩小。结论　TMLR能缓解心绞痛 ,改善生活质量     

冠心宁片对Beagle犬急性心肌缺血的作用

目的:观察冠心宁片对Beagk犬急性心肌缺血模型缺血心肌的保护作用.方法:将体重(12±2)kg的健康Beagk犬48只,随机分为伪手术组、模型对照组、冠心宁片高、中、低剂量组、阳性对照(冠心宁注射液)组,各组每日给予相应的药物,连续10天后,用二步法结扎冠状动脉,造成Beagle犬急性心肌缺血,检则结扎后30min、60min、120min、180min的CK-MB、LDH水平、MDA含量和SOD活性.结果:冠状动脉结扎后,急性心肌缺血犬的CK-MB水平、LDH水平上升,MDA含量升高,SOD活性下降.给予高、中、低剂量冠心宁片组可明显降低CK-MB水平(P＜0.05),降低LDH水平(P＜0.05),降低MDA含量(P＜0.05),提高SOD活性(P＜0.05).结论:冠心宁片可有效降低Beagle犬急性心肌缺血程度,提高其自由基清除能力和抗氧化能力,对犬的缺血心肌的保护作用.     

Assessment of myocardial perfusion by positron emission tomography in patients with end-stage coronary artery disease treated with percutaneous myocardial revascularization

Background Reportedly, patients with persistent refractory angina due to end-stage coronary artery disease （CAD） not amenable to traditional revascularization techniques have experienced symptomatic relief following laser revascularization, either surgical transmyocardial revascularization （TMR） or percutaneous myocardial revascularization （PMR）. In spite of several hypotheses （i.e., channel patency, placebo effect, denervation, neoangiogenesis）, the mechanism of action and the benefit remains controversial. Methods A prospective trial utilizing positron emission tomography （PET） was conducted as an attempt to correlate quantified myocardial blood flow （MBF） to clinical improvement following PMR. Thirteen consecutive patients with angina class 〉11 in spite of maximal medical treatment underwent PMR with a holmium：yttrium-aluminum-garnet （Ho：YAG） laser. MBF at rest and under hyperemia was assessed by [13N]ammonia PET at baseline, 3 and 6 months following PMR. Results Mean angina class and exercise tolerance time improved at 6 months compared with baseline （P 〈0.001）. The clinical results were accompanied with an improvement in hyperemic MBF （P=-0.05） and a reduction in minimal coronary resistance （MCR; P 〈0.05） in PMR-treated segments. Opposite effects, reduced hyperemic MBF and increased MCR, were observed in nontreated segments. The increase in MCR in nontreated segments revealed the favorable therapeutic impact achieved in PMR-treated segments. Conclusion The results of this trial utilizing a quantitative technique to quantify myocardial perfusion link clinical improvement post-PMR to neoangiogenesis and consistently improved microcirculation.