异丙酚对离体大鼠缺血/再灌注心肌线粒体膜流动性的影响

本研究通过观察心肌线粒体膜流动性的变化,评价异丙酚对再灌注心肌细胞的保护作用。 材料与方法 Wister大鼠24只,雌雄不拘,体重280-320 g。将离体心脏悬于改良Langendorff灌流装置上,主动脉逆灌注37℃Krebs-Henseleit缓冲液(K-H液),灌注压76 cm H2O(1 cm H2O     

两种组织黏合剂封堵肺创面漏气的研究

目的 探讨纤维蛋白胶(FG)和化学胶封堵肺创而漏气的临床价值.方法 FG先行体外耐压试验.将54只新西兰兔随机分为3组:对照组、FG组和化学胶组,每组18只.离体实验每组9只兔,分别注射40、50、60 ml空气行肺顺应性测定.在体实验每组9只兔,建立兔肺漏气模型.对照组关胸,另两组行FG及化学胶封闭肺创面做加压试验,术后3、7、14 d开胸观察取肺组织行苏木素-伊红(HE)染色.结果体外耐压试验中,FG承受50 cm H2O压力后出现漏气.离体实验中,FG组顺应性(1.820±0.280、1.181±0.144、0.947±0.080)与对照组(2.075±0.377、1.289±0.243、0.951±0.087)比较差异无统计学意义(P>0.05),化学胶组顺应性(1.594±0.294、0.956±0.094、0.861±0.076)与对照组、FG组比较明显减小(P<0.05).在体实验中,对照组兔在术后1～4 h内死亡,FG组在肺内压平均达到27.2 cmH2O时出现漏气,而当气道压达34 cmH2O时化学胶亦未漏气.化学胶组术后出现肺不张及少量胸水,病理切片示坏死组织及炎性细胞明显多于FG组.结论 两胶均可有效封闭肺创面漏气.与化学胶比较,FG对肺顺应性干扰小,可促进创面愈合、减轻炎症及瘢痕形成.     

肝硬变隔离灌流模型的血流动力学研究

目的：用隔离灌流的鼠肝硬变模型（IPCM）对硬变肝脏的循环顺应性进行观测。方法：CCl4诱导的肝硬变大鼠60只分成6组，分别按基础流量及15、25、35、45、55ml/min的不同灌流率行肝灌流，测量相应的血流动力学参数。结果：与肝硬变对照组1．6±0.3kPa(16.8±2.9cmH2O）的基础压力相比，35－55ml/min的高灌流率伴有门静脉压力从2.5±0.4-3.9±0.7kPa(26±4－40±7cmH2O)的迅速升高，灌流率的增大与门静脉压力的升高间有高度相关性（r=0.985;P<0.001)，肝内阻力则变化不大（P＞0．05）。IPCM的最大稳定灌流范围为15－35ml/min，较文献报告的IPRL范围明显缩小。各组肝内阻力变化不大（P＞0．05），门静脉压力的上升主要源于向肝血流量的增加，提示肝内血管床顺应性下降。结论：（1）肝硬变门静脉高压症时肝内循环顺应性下降而向肝血流量增加；（2）IPCM是研究肝脏病、生理变化的好方法。     

热休克预适应提高兔心一氧化氮释放的研究

我们采用改良Ｌａｎｇｅｎｄｏｒｆｆ离体兔心灌注模型 ,观察热休克预适应模型对保存 6ｈ兔心的一氧化氮 (ＮＯ)水平的影响及其对长期供心的保存效果。一、材料与方法1.实验方法 :将 2 0只健康成年新西兰白兔随机平均分为两组。Ⅰ组为对照组 ;Ⅱ组为热休克组 ,将兔置于恒温加热平台 ,缓慢使家兔体温升高 ,使肛温达 42℃保持 15ｍｉｎ ,自然环境中恢复 2 4ｈ后处理。采用Ｌａｎｇｅｎｄｏｒｆｆ离体兔心灌注模型 ,肝素化后正中开胸取心 ,4℃林格液中行主动脉插管 ,灌注压力为 7.8ｋＰａ( 1ｋＰａ =7.5ｍｍＨｇ) ,流量为 2 5～ 30ｍｌ/ｍｉｎ…     

肾盂恒压灌注对肾损伤的实验研究

目的:研究兔单侧输尿管逆行恒压灌注后对肾脏的影响,为临床评价内腔镜操作所致肾脏的改变提供理论依据。方法:分别建立左侧输尿管皮肤造口的动物模型:健康家兔50只,随机分为5组(每组10只),假手术组只造瘘不灌注,灌注组输尿管造瘘后立即行逆行灌注,灌注压力分别为60、80、100、120cmH2O(1cmH2O=0.098kPa),术后每天留取尿标本定量测定尿白蛋白(AlB),连续取肾组织行病理检查监测兔肾形态学改变。结果:所有灌注兔肾术后都出现尿白蛋白增高,术后第1天与术前相比差异均有统计学意义(P<0.01),且术后第一天在各组间比较差异有统计学意义(P<0.05),从60cmH2O到120cmH2O各组尿蛋白恢复的时间分别为3、4、5、6天;形态学上表现:肉眼观灌注后肾脏颜色逐渐变深,包膜紧张,肾脏较前增大,在压力超过100cmH2O时,19例中有16例出现明显的水外渗。术后再次取病理时见肾脏大小、颜色无明显改变。显微镜下观察见肾集合系统扩张,随着压力增高高倍镜下每个视野扩张的肾小球、肾小管所占的比例越来越多,扩张的程度越来越重。结论:压力为60～120cmH2O对兔肾盂进行灌注时,在短期内会出现尿白蛋白增高及形态学改变,提示肾功能损害,且压力越高,肾功能损害越严重,恢复时间越长。     

11,12-环氧二十碳三烯酸预处理对未成熟兔离体心脏的影响

目的　观察 11,12 环氧二十碳三烯酸 ( 11,12 EET)预处理对离体未成熟兔心肌缺血再灌注的保护作用 ,并探讨其可能机制及意义。方法　利用Langendorff灌注装置 ,建立心肌缺血再灌注模型。 2 4只未成熟兔随机分成对照组、缺血预处理组 (IPC组 )、11,12 EET预处理组 (EET组 ) ,观察常温缺血 ( 3 7℃ ) 2h再灌注 1h前后心功能变化 (左室变化压、左室舒张末期压、心室最大压力变化速率、冠状动脉流量等指标 )、心肌含水量、心律失常评分、心肌酶学 [肌酸激酶 (CK )、乳酸脱氢酶 (LDH ) ]指标。结果　IPC组及EET组心功能恢复、心律失常发生及心肌酶学指标均优于对照组 ;与IPC组相比 ,EET组的心肌含水量 ( 75 .3± 3 .5 ) %、CK( 117.4± 8.3 )IU/L、LDH ( 5 2 .7±13 .4)IU/L均较低 (P <0 .0 5 ) ,冠状动脉流量 ( 12 .7± 1.5 )ml则较大 ,这两组的其余观察指标差异无显著性 (P >0 .0 5 )。结论　 11,12 EET预处理未成熟兔离体心脏能产生优于缺血预处理的心肌保护作用。     

输精管激光节育法研究

1996年 2月以来 ,用自制的Ｎｄ∶ＹＡＧ便携式激光节育仪 ,激光源Ｎｄ∶ＹＡＧ ,波长 10 6 0ｎｍ ,裸露光纤直径 0 .6ｍｍ。输精管穿刺用套管针 (2 0Ｇ)。以兔离体输精管小段 12 0段、活兔健康兔 15 0只、人离体输精管 5 4小段为材料。方法 :(1)将光纤直接插入兔离体输精管小段     

肺表面活性物质及呼气末正压对呼吸衰竭的作用

目的　探讨肺表面活性物质 (PS)在不同呼气末正压 (PEEP)下对洗肺鼠呼吸衰竭的作用。方法　 5 6只Wistar大鼠 (体重 30 0～ 35 0 g)在戊巴比妥钠 (30mg/kg)腹腔内麻醉下人工呼吸并用生理盐水洗肺 ,共洗 8～ 11次 ,洗肺期间吸入峰压及PEEP分别调至 2 5cmH2 O和 7 5cmH2 O。当PaO2 降至 90mmHg以下时 ,随机分为八组 ,每组 7例。 1～ 4组经气道注入PS 2 5mg(0 5ml) ,5～ 8组则经气道注入等量的生理盐水 (0 5ml)。 1组和 5组的PEEP为 7 5cmH2 O ,2组和 6组的PEEP为5cmH2 O ,3组和 7组的PEEP为 2 5cmH2 O ,4组和 8组的PEEP为 0cmH2 O。结果　未注入PS的 5～ 8组的PaO2 在整个实验中未见明显变化 ,均在 10 0mmHg以下。注入PS的 1～ 4组中 ,无PEEP的第 4组及 2 5cmH2 OPEEP的第 3组的PaO2 未见明显改善 ,与 5～ 8组之间未见显著差异 (P >0 0 5 )。第 2组的PaO2 虽在注入PS后 15分钟明显升高至 (34 3 5 3± 132 2 6 )mmHg ,但以后逐渐下降至治疗前水平。只有第 1组的PaO2 在治疗后显著的升高至 40 0mmHg以上 (P <0 0 5 ) ,并维持此高值至实验结束。结论　单独PEEP不能改善洗肺鼠的低氧血症 ,补充PS并附加 7 5cmH2 O的PEEP可明显改善低氧血症     

液压扩张对内皮细胞前列环素分泌功能的影响

目的：研究液压扩张对内皮细胞分泌的血管舒张因素因子前列环素（PGI2）的影响。方法：采用新西兰成年健康大白兔24只，对其右侧颈总动脉用不同压力（Pa=40,80,120,0cmH2O,1cmH2O=0.098cmHg)进行液压扩张，并在扩张前，扩张后1h,3h,6h,12h,24h,48h,72h，共8个时间段自耳静脉取血。用放射性同位素方法，测定液压扩张后不同时间国际通用的PGI2代谢产物α－Keto-PGI2的含量来供表PGI2的水平。结果：压力为40cmH2O时，内皮细胞分泌PGI2水平下降，与对照组（0cmH2O0相比差异无显著性意义（P＞0．05）；随着时间的延长，PGI2的水平呈现上升趋势。压力为80cmH2o时除3h组显著下降外；其它不同时间段PGI2的分泌也受到轻度抑制，与对照组相比差异均无显著性意义（P＞0．05）。压力上升至120cmH2O时，每个时间段PGI2的分泌均低于对照组水平，差异有显著性意义（P＜0．05）。结论：液压扩张在一定压力范围内（P≤80cmH2O)对PGI2的分泌没有明显影响；而当压力超过120cmH2O时，PGI2的分泌受到明显抑制。     

11,12-EET长时间保存未成熟离体兔心的初步研究

目的探讨11，12-EET(11，12-epoxyeicosatrienoic acid)对未成熟兔离体心脏缺血再灌注损伤的保护作用及机制。方法利用非循环式Langendorff灌注装置将16只未成熟离体兔心制成缺血再灌注模型，随机分成对照组(st．Thomas No．2液为停搏液及保存液)和实验组(st．Thomas No．2液加ll，12-EET为停搏液及保存液)。测定心脏保存(4^。C)8h、再灌注(37^。C)30min的心功能指标：左心室变化压、舒张末压、最大压力变化速率、冠状动脉流量以及心肌含水量、心律失常评分和心肌酶CK、LDH、心肌超微结构改变等。结果(1)实验组的心功能恢复率、心肌水肿程度、心肌超微结构和心肌酶及心律失常评分改变均优于对照组。(2)与保存前相比，实验组的心功能无显著性改变，心功能恢复基本接近保存前水平。结论St．Thomas No．2液中加人11，12-EET可增强对未成熟兔离体心脏的保存效果。     

An experimental study on supraventricular dysrhythmias after intracardiac surgery, with special reference to relationship between injury of the internodal tract and atrial flutter]

Dysrhythmias after atrial reparative surgery for TGA or ASD can be lethal. Experiments were made to analyze their mechanism, and to search preventive methods. 1. Acute effects of atrial incisions were studied by epicardial mapping on the right atriums (RA) subjected to various incisions with or without internodal tract (INT) involvement 101 dogs. Atrial rapid pacing was used to induce sustained AF or af. 2. Chronic effects of atrial incisions were studied on longitudinal incisions with (8 dogs) or without (8 dogs) posterior INT (PINT) involvement. Few months later they were subjected to mapping, inducibility of AF, and histologic study of hearts. 3. Mechanism of induced AF was analyzed using reentrant circuit of AF in the longitudinal PINT incision group. At acute stage, conduction delay specific to each freewall incision was observed. AF or af was induced in 70.0% of the longitudinal incision with PINT involvement, but only in 1 dog without PINT. At chronic stage, AF was induced in 5 dogs (62.5%) which included 4 dogs not showed AF at acute stage. Marked chronic changes were histologically showed in injured atrial portion. Reentrant circuit of AF was demonstrated on RA near tricuspid orfice. The PINT kept intact is important to prevent AF.     

The effect of maze operations on atrial volume

BACKGROUND: Unmodified maze III operations show long-term eradication of atrial fibrillation (AF) in more than 85% of patients with or without structural heart disease. The effect of this procedure on atrial volumes is not known. METHODS: Two patient populations were studied: (1) patients undergoing unmodified maze III operations combined with surgical structural heart disease, mostly mitral valve operations (group A; n = 32); and (2) patients with only AF selected for unmodified maze III operations (group B; n = 32). In groups A and B, transthoracic Doppler echocardiographic studies were prospectively made preoperatively, and at 3 and 12 months postoperatively. Left and right atrial dimensions and volumes and atrial contractions were determined and compared with base line patient characteristics and 12 months arrhythmia outcomes. RESULTS: One year postoperatively all patients were alive. In groups A and B, 92% were free of AF and other atrial arrhythmias. A significant reduction of left atrial volume at 1 year postoperatively was apparent in group A, whereas the left atrial volume did not change significantly in group B. The reduction observed in group A was not related to postoperative age, type or duration of AF, or late atrial arrhythmia outcome. In both groups the right atrial volume remained unchanged at 12 months postoperatively. CONCLUSIONS: The unmodified maze III operation does not affect atrial volume in patients without structural heart disease. In patients with structural heart disease, the mitral valve operation contributes to the reduction of left atrial volume and dimension by improving the hemodynamic condition.     

双心房或单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动的对比研究

目的分析双心房射频消融术与单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动（房颤）的效果。方法回顾性分析2007年1月至2012年12月47例房间隔缺损合并心房颤动接受房间隔缺损修补联合射频消融术治疗患者的临床资料,其中男20例,女27例;年龄35～76岁;房颤病程3个月至15年;持续性房颤18例,长程持续性房颤29例。合并二尖瓣轻度至中度以上关闭不全10例,三尖瓣轻度至中度以上关闭不全28例。根据手术方式不同将47例患者分为两组,单纯右心房消融组（n=19）：行房间隔缺损修补术＋单纯右心房射频消融术;双心房消融组（n=28）：行房间隔缺损修补术＋双心房射频消融术。对于二尖瓣、三尖瓣存在轻一中度以上反流者,术中同期行二尖瓣、三尖瓣成形术。所有患者术后3个月、6个月、12个月均接受24h动态心电图检查,1年后间断门诊随访。结果双心房消融组的体外循环时间、主动脉阻断时间及术后住院时间较单纯右心房消融组略长,但两组术后早期并发症及恢复情况无明显差异。心脏复跳时,双心房消融组25例（89．3％）直接恢复窦性心律,3例为交界心律,无房颤心律。单纯右心房消融组14例（73．7％）直接恢复窦性心律,2例为交界心律,3例为房颤心律。出院时,双心房消融组28例（100％）均维持窦性心律;单纯右心房消融组15例（78．9％）维持窦性心律,4例房颤复发（P=0．045）。所有患者均得到随访,随访时间3～75个月,全组无死亡病例;房间隔无残余分流;2例出现二尖瓣轻一中度以上关闭不全,4例出现三尖瓣轻．中度以上关闭不全;双心房消融组术后2年累积窦性心律维持率为87．7％±6．7％,明显高于单纯右心房消融组的47．4％±11．5％（P=0．003）。结论对于成人房间隔缺损合并房颤,双心房射频消融术较单纯右心房射频消融术有更好的治疗效果,而且不会增加手术的风险。     

MicroRNA-1、MicroRNA-133、MicroRNA-34a及其可能靶蛋白Ankyrin-B在心房颤动患者心房组织中的表达及意义

目的 通过检测心房颤动（房颤）与窦性心律患者右心耳组织中microRNA-1、microRNA-133及microRNA-34a的表达差异,及其可能靶蛋白锚蛋白-B （Ankyrin-B ）的表达变化,分析两者之间的关系,以从microRNAs调控水平研究房颤发生、发展的新机制。 方法 将第三军医大学新桥医院40例风湿性心瓣膜病行心瓣膜置换术患者分为房颤组［男8例,女12例;年龄（52.9±5.8）岁］和窦性心律组［男9例,女11例;年龄（52.4±6.2）岁］ 。采用逆转录-实时定量聚合酶链式反应（RTQ-PCR,Real-time quantitive PCR）法检测患者右心耳组织中microRNA-1、microRNA-133及microRNA-34a的表达,ΔΔCt法计算结果;石蜡切片免疫组织化学法检测组织中Ankyrin-B的表达;蛋白免疫印迹（Western Blotting）法检测组织中Ankyrin-B的表达变化。 结果 房颤组患者右心房组织中的microRNA-1表达较窦性心律组显著降低（0.559±0.252 vs. 3.997±1.251;t =-21.455,P=0.000）,microRNA-133的表达较窦性心律组显著降低（0.630±0.238 vs. 5.514±1.549;t =24.133,P=0.000）,而microRNA-34a的表达较窦性心律组增高（4.783±2.012 vs. 1.350±0.638,t =12.596,P=0.000）。免疫组织化学法及Western Blotting均显示房颤组心房组织Ankyrin-B表达较窦性心律组明显降低,且差异有统计学意义（0.66±0.45 vs. 1.09±0.42;t =-3.396,P=0.001）。结论 MicroRNA-34a可能通过调节Ankyrin-B蛋白的表达,从而参与心房颤动的发生、发展。     

Atrial compartment operation for atrial fibrillation: to isolate the left atrium or not?

BACKGROUND: The atrial compartment operation was designed to convert atrial fibrillation (AF) to sinus rhythm with intentional preservation of the electrical connection between adjacent atrial compartments. However, incidental left atrial isolation was observed in some patients. This study compared the long-term clinical outcomes of left atrial isolation for AF with those with right and left atrial connection. METHODS: Twenty patients with mitral valve disease and chronic AF who underwent atrial compartment operation with successful sinus conversion were studied. Left atrial isolation was documented by local electrogram recording. When there were no signs of electrical connection between the left atrium and the rest of the heart, either during sinus rhythm or during stimulation from various atrial compartments, left atrial isolation was confirmed. All patients were followed by electrocardiogram and echocardiogram serial recordings. Clinical signs and symptoms of cardiac performance and thromboembolism were also examined. RESULTS: Seven patients showed an isolated left atrium and 13 patients had electrical connection between the right and left atria. The age, gender, AF duration, and underlying disease were not different between the two groups of patients. During a mean follow-up period of 66 +/- 15 months, none of the patients with left atrial isolation showed recurrence of AF, although one experienced paroxysmal atrial flutter. However, 8 of the 13 patients with right and left atrial connection experienced recurrent atrial flutter/fibrillation (6 atrial flutter and 5 AF) (p = 0.058). The propensity for recurrent atrial flutter/fibrillation in these patients may be related to the conduction delay between the two atrial compartments, measured at 142 +/- 48 ms. At the end of the follow-up period, all patients with left atrial isolation remained in normal sinus rhythm without antiarrhythmic drugs. Of the patients who had right and left atrial connection, 2 developed sustained AF and 1 developed atrial flutter. Patients with left atrial isolation showed a decreased transmitral "A" flow compared with those with right and left atrial connection. Postoperative left atrial diameter and clinical functional class did not differ between patients with and without left atrial isolation. The incidence of embolization observed in both treatment groups did not differ significantly: 14% (1/7) in patients with left atrial isolation and 8% (1/13) in patients with right and left atrial connection (p > 0.05 between the groups). CONCLUSIONS: Left atrial isolation confers a better arrhythmia outcome but at the expense of poorer mechanical performance as compared with preserved electrical connection between the two atria. Nonetheless, all patients remain at risk for systemic embolization. Therefore, modifications of current surgical incisions for AF are needed.     

Right atrial separation effect for chronic atrial fibrillation with atrial septal defect: report of four cases.

We operated on 56 adults diagnosed with atrial septal defect (ASD) between 1990 and 2004. Of these, eight had complications of atrial fibrillation (AF) in the preoperative period. After 1998, right atrial separation was performed in four cases. Marked improvement was noted in three out of the four cases. The right atrial separation procedure was a simple, easy, and effective method for the treatment of chronic AF associated with ASD.     

Experimental evaluation for tricuspid annular constriction with the model of tricuspid annular dilatation

We have obtained the good result about tricuspid annular constriction (TAC) for secondary tricuspid insufficiency. The purpose of this study is to investigate the effectiveness of TAC for the experimental model of tricuspid annular dilatation. First of all, tricuspid annular dilatation was made surgically in 8 mongrel dogs by placing 8 incisions to tricuspid annulus except septal cusp under the condition of heart-lung preparation. On clinical evaluation, septal annulus was kept to be intact in many cases compared with the two other areas. This experimental model of tricuspid annular dilatation was considered to be substituted to the clinical model of tricuspid annular dilatation. TAC suture was surrounded circumferentially around the dilated tricuspid annulus. And then, TAC suture was pulled out from the right atrial wall, and the circumferential length of tricuspid annulus was completely accommodated by pulling the TAC suture. The hemodynamic status was observed by right atrial pressure (V wave and mean) and right ventricular end-diastolic pressure (RVEDP). After heart resuscitation and gradual increase of preload, right atrial pressure was significantly elevated especially right atrial pressure (V wave) compared with control values. When 2 cm of circumferential length of tricuspid annulus on an average was constricted by shortening of TAC suture, right atrial pressure was significantly decreased, and then RVEDP tended to decrease. It was shown that TAC was an effective operative technique for the secondary tricuspid annular dilatation and tricuspid insufficiency from the standpoint of experimental aspect as well as clinical results.     

What are the predictors of restoration of sinus rhythm after combined treatment with surgical repair for organic heart disease and the Maze procedure for atrial fibrillation?

BACKGROUND: Recently, combined treatment using the Maze procedure for organic heart disease and atrial fibrillation has been reported, but there have been few studies of cardiac rhythm after combined treatment. Predictors of cardiac rhythm after combined surgical treatment have been unknown. METHODS: Thirty patients who underwent cardiac surgery with the Maze procedure were retrospectively enrolled in this study. Two groups consisted of the patients with restoration of sinus rhythm after surgery (SR: n=15, 6 males and 9 females, mean age of 64 years), and the patients with maintenance of atrial fibrillation (AF; n=15, 5 males and 10 females, mean age of 61 years). Before cardiac surgery, all patients underwent exercise testing with measurement of atrial natriuretic peptide (ANP) before and after exercise testing, two-dimensional echocardiography, and right and left heart catheterization. RESULTS: The mean maximal heart rate and the ANP level after exercise testing in SR were significantly higher than those in AF. The left atrial dimension and right atrial and pulmonary capillary wedge pressures were significantly higher in AF than in SR. These findings indicate that subjects in SR exhibited less impaired atrial function which were evaluated by exercise testing with measurement of ANP, echocardiography, and cardiac catheterization. CONCLUSIONS: The atrial function of patients with sinus rhythm after the Maze procedure may be less impaired than that of patients remaining in atrial fibrillation.     

外科射频消融术与经导管消融术治疗瓣膜病性房颤的疗效对比

目的 比较心内直视下射频迷宫术与介入导管消融术治疗合并心脏瓣膜病的心房颤动临床结果.方法 2004年1月到2006年3月因心脏瓣膜病合并心房颤动行瓣膜置换时加射频迷宫术60例,其中男34例,女26例;平均(57±11)岁.瓣膜置换术后在三维电解剖标测系统(CABTO)指导下进行经皮经导管环肺静脉消融治疗66例,其中男40例,女26例;平均(55±10)岁.结果 导管消融组随访(14±10)个月,窦性心律维持率64%.外科射频迷宫组随访(13±9)个月,窦性心律维持率75%,二者差异有统计学意义(P<0.05).对于病史小于1年、左房直径<50mm的阵发性房颤,导管消融组亦有较高的窦性心律维持率(分别为90%、82%).两组术后并发症无显著性差异.结论 射频迷宫术对瓣膜病合并心房颤动病人是简单、有效的治疗方法.若未行迷宫术,对于病史小于1年,左房直径小于50mm的阵发性心房颤动,瓣膜置换术后行经皮经导管消融术亦为一种有效的治疗方法.     

Hemodynamic Effects of Cardiomyoplasty in an Experimental Model of Acute Heart Failure and Atrial Fibrillation

Abstract: The aim of our work was to study the hemodynamic effects of dynamic cardiomyoplasty on an acute animal model of atrial fibrillated heart failure. Eight anesthetized open chest dogs suffering from atrial fibrillation and heart failure, obtained by topic acetylcholine and propranolol, were treated by a cardiomyoplasty procedure performed with an electrostimulated latissimus dorsi muscle flap (LDMF). Values considered for analysis during LDMF stimulation were selected from cardiac cycles with R-R intervals similar to those when the LDMF was not stimulated (±20 ms). Atrial fibrillated heart failure showed a significant increase of systemic vascular resistance, end diastolic left ventricular pressure (EDLVP) and right atrial pressure (p < 0.05), and a significant decrease in cardiac output, systolic left ventricular pressure (SLVP), and mean aortic pressure (p < 0.05) compared with control values. LDMF stimulation in atrial fibrillated heart failure resulted in a significant increase of SLVP, cardiac output, and mean aortic pressure (p < 0.05) and a significant decrease of systemic vascular resistance, EDLVP, and right atrial pressure (p < 0.05) compared with nonstimulated values. The highest LVP values were obtained with R-R intervals long enough to allow an adequate LV filling. We conclude that dynamic cardiomyoplasty provides an appropriate recovery in this animal model of atrial fibrillated heart failure. Cardiomyoplasty is an appropriate procedure for cardiac assist when R-R intervals allow an adequate LV filling.