新型房间隔造口支架在犬实验中的初步研究

目的:观察新型房间隔造口支架置入动物体内后的组织学反应,评价其可行性及安全性.方法:选用杂种实验犬8只,非体外循环下通过介入或外科方法进行创伤性房间隔造口术,直视下或经超声及透视下引导置入不同大小的新型房间隔造口支架,术后1周、2周、3周、4周、8周分别进行超声心动图检查了解造口通畅性,并处死动物进行大体解剖、光镜和电...     

房间隔单线消融与迷宫式多线消融防治实验性心房颤动的对 …

目的 比较房间隔单线消融与心房迷宫式多线消融防治心房颤动（ＡＦ）的效果。方法 选用闭胸１３只和开胸６只犬，在静脉滴注乙甲胆碱下用心房快速起搏诱发持续性ＡＦ。Ｉ组犬经皮穿刺静脉，在Ｘ线透视下用７Ｆ温控四极同步消融导管介导射频能量消融卵圆窝前方的宽厚房间隔。Ⅱ组在开胸直视下由心外膜逐步消融左、右肺静脉口、左心耳根部、腔静脉间心肌束、右心耳根部、上腔静脉至三尖瓣环间前侧心肌及Ｂａｃｈｍａｎｎ（ＢＢ）束，     

新型改良房间隔造口支架的初步动物实验研究

目的现有房间隔造口支架效果不佳,本项目研发一种新型改良房间隔造口支架,通过动物体内实验,观察造口效果及组织学反应,评价其生物相容性、安全性及有效性。方法选用中国实验用小型猪7只,采用右侧开胸非体外循环下经超声引导房间隔穿刺置入新型改良房间隔造口支架,术后随访1、3、6个月至实验终点处死,进行大体解剖、光镜和电镜观察。结果共有6只实验猪成功置入房间隔造口支架并随访至实验终点,1只实验猪因术中出血过多而放弃房间隔造口术。6只置入房间隔造口支架的实验猪大体解剖示造口支架位置良好,未发生移位,支架表面未见明确赘生物及血栓形成,但支架表面内膜化,造口闭塞。显微光镜观察示1例支架周围心肌出现坏死伴纤维化,余邻近组织未见炎性反应及异物巨细胞聚集,周围心肌未见坏死,肺、肝、脾、肾脏等重要脏器均无细胞坏死、血栓栓塞现象。扫描电镜观察示支架表面可见大量纤维组织包裹,表面光滑,未见血栓及赘生物形成,支架边缘部分纤维表面可见部分内皮样细胞覆盖,未见完全内皮化。结论新型改良房间隔造口支架具有良好的生物相容性及组织安全性,经导管准确置入房间隔是安全可行的,可重复性好,不易发生支架的脱落、移位及变形回缩,有望解决既往房间隔造口回缩、维持时间短的问题,但本次实验造口效果欠佳,新型房间隔造口支架仍需进一步改进与完善。     

带孔房间隔分流器治疗肺动脉高压犬的短期疗效初探

目的初步探讨带孔房间隔分流器治疗肺动脉高压犬模型的短期疗效。方法健康雄性比格犬36只, 犬龄1～2岁, 采用简单随机抽样法分为经导管球囊扩张房间隔造口术(BAS)+分流器组、BAS组和无造口组3组, 每组12只。在犬右心房内注射脱氢野百合碱(1.5 mg/kg), 建立肺动脉高压模型。建模成功后, BAS+分流器组犬行BAS, 术后置入带孔房间隔分流器, BAS组犬行球囊扩张房间隔造口术, 无造口组犬不予任何干预。于建模前, 建模后2个月, 手术治疗后1、3、6个月, 分别测量各组犬的血流动力学指标及血N末端B型利钠肽原(NT-proBNP)水平。于手术治疗后1、3、6个月对BAS组和BAS+分流器组犬行超声心动图检查, 观察分流器及房间隔造口的开通情况。于手术治疗后1、3、6个月各组分别处死3只犬, 取心脏房间隔组织及房间隔分流器进行大体观察, 观察分流器内皮化情况;取肺组织进行苏木素-伊红(HE)染色, 观察肺中小血管附近炎症细胞浸润以及肺血管内膜增厚和狭窄的情况。结果 2只犬在建模后24 h内死亡, 剩余34只犬, 其中BAS+分流器组12只、BAS组11只、无造口组11只。与B...     

超声内镜引导肝内门静脉穿刺在经颈静脉肝内门体分流术中的实验研究(含视频)

目的探讨经颈静脉置入超声内镜并直视引导肝内门静脉穿刺在经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt, TIPS)中的可行性及安全性。方法以5只比格犬为研究对象, 麻醉后经颈静脉置入超声内镜, 进入肝段下腔静脉及肝右静脉入口处, 观察肝内门静脉情况, 实时引导下穿刺门静脉并置入支架, 完成TIPS。结果 5只比格犬中1只因颈外静脉管径较细无法置入超声内镜, 其余4只均经颈外静脉置入超声内镜并在其实时引导下完成门静脉穿刺。完成后续支架置入、球囊扩张等操作, 实验结束后动物均存活。结论经颈静脉置入超声内镜并直视引导下肝内门静脉穿刺在TIPS中是安全可行的。     

打孔法建立犬同等大小房间隔缺损动物模型的研究

目的:探讨非体外循环房间隔打孔法建立犬同等大小房间隔缺损(ASD)动物模型的可行性。方法:将健康杂种犬9只开胸后,通过右心房心外膜触诊房间隔判断卵圆窝的位置。切开卵圆窝相对应的右心房壁,插入6 mm大小自制的房间隔打孔器并垂直推送打孔器穿刺房间隔,环形切割房间隔组织建立ASD模型。结果:9只犬的ASD模型均成功建立。2只犬术后解剖观察,ASD直径分别为6.0 mm和6.1 mm,与自制打孔器的大小相符,其余7只用经胸超声心动图(TTE)检查ASD直径为(6.0±0.2)mm,均为中央型ASD。全部犬均未发现心包积液等并发症。结论:以非体外循环房间隔打孔法可建立同等大小的ASD动物模型,本法成功率高、并发症少,值得推广。     

下腔静脉造影指导犬房间隔穿刺术

目的　介绍下腔静脉造影指示下犬房间隔穿刺术方法。方法　对9只健康杂种犬进行了下腔静脉造影指示下的房间隔穿刺术。全麻下经皮穿刺右侧股静脉,X线投照角度RAO 30°,经Mullins鞘管注射76 %的泛影葡胺2 0mL行下腔静脉造影,分别显示下腔静脉及其开口、右心房影、左心房影和主动脉根部影,将Brockenbrough穿刺针远端弯度的近端塑形增加1个弯度,使穿刺针方向指示器指向3点左右、针尖顶至房间隔进行穿刺。结果　( 1 )下腔静脉造影显示与房间隔穿刺有关的解剖特征为下腔静脉开口位置高,全部在房间隔中上部,使房间隔穿刺点位置也高,加上左心房腔小,穿刺针易穿至左心房顶部;( 2 )下腔静脉造影指导下房间隔穿刺术成功率为1 0 0 % ( 9/ 9) ,心脏压塞1例,经X线和造影剂指示心包穿刺引流术控制。结论　下腔静脉造影指导下的经皮犬房间隔穿刺术简单易行。     

国产镍钛记忆合金房间隔封堵器的实验研究

目的:通过外科创建的房间隔缺损动物模型评价国产镍钛记忆合金封堵器的封堵效果和组织学反应。方法:将犬房间隔造口建立房间隔缺损动物模型后,利用国产镍钛记忆合金房间隔封堵器进行封堵,术后4h、15h、1、2、3个月分别进行大体解剖和光镜、电镜检查。结果:5只犬成功建立了动物模型并1次封堵成功,完成4h～3个月随访。动物生长发育正常,无严重并发症出现。15d～3个月大体解剖可见封堵器与房间隔组织紧密嵌合,表面完全被一层半透明、光滑的新生组织所覆盖,光镜及透射电镜检查证实为内皮样细胞。结论:国产镍钛记忆合金封堵器封堵外科创建的房间隔缺损动物模型是可行的。     

生物可完全降解封堵器封堵犬卵圆孔未闭的实验研究

目的 评估生物可完全降解卵圆孔未闭（patent foramen ovale，PFO）封堵器封堵犬PFO的可行性、安全性等。方法 右胸小切口开胸卵圆窝穿刺法建立犬PFO模型，即刻在直视及经胸超声心动图（TTE）引导下用生物可完全降解型PFO封堵器封堵PFO。在植入后分别于1、3、6、9和12个月各处死2只犬，进行肉眼和组织学检查。结果 10只犬成功建立PFO模型后并植入可完全降解PFO封堵器。随访见封堵器均未发生移位，表面无赘生物及血栓形成，大体解剖见内膜组织从边缘逐渐完全覆盖封堵器表面。组织病理学提示，术后6个月封堵器骨架几乎完全降解并和周围组织融为一体。结论 应用生物可完全降解PFO封堵器封堵犬PFO，降解后在体内无任何残留物，是一种安全、有效并且可行的封堵器。     

经胸超声引导下无放射线经皮房间隔缺损伞堵术6例分析

目的:总结一种新的无放射线的局麻下股静脉穿刺径路经胸超声引导下房间隔缺损伞堵术临床结果。方法:6例患者(男性3例,女性3例),诊断中央型房间隔缺损(缺损直径18~38mm),心功能正常,无合并其他心内畸形,无其他系统功能障碍,采用新的手术方法,于外科手术室(无放射设备),局麻下经股静脉径路,经长鞘管,在经胸超声引导下行房间隔伞堵术。结果:6例封堵术均取得成功,耗时12~56分钟,6例手术均无须行其他麻醉、无须改其他切口,6例患者无须进入ICU,术后无封堵伞脱落,术后复查无明显残余分流。术后平均住院时间2.7天。结论:无放射线的局麻下股静脉穿刺径路经胸超声引导下房间隔缺损伞堵术作为一种微创、无放射线损伤的新的手术方式,可以为外科医生治疗一些较简单的房间隔缺损患者提供选择。     

Assessment of bedside umbilical vein balloon septostomy using two-dimensional echocardiographic guidance in transposition of great arteries

The effectiveness of "bedside" balloon atrial septostomy via the umbilical vein using 2-dimensional echocardiography was compared to the traditional femoral vein approach using fluoroscopy in a series of neonates with transposition of great arteries from March, 1984 to April, 1987. There were 7 neonates who had balloon septostomy performed at the "bedside" (Group I) compared to 13 who had the procedure performed in the catheterization laboratory (Group II). Group II consisted of 7 newborns who had elective femoral vein catheterization under fluoroscopy (Group IIA) and 6 who failed "bedside" umbilical vein balloon septostomy and subsequently had the femoral vein approach under fluoroscopy (Group IIB). Results showed that adequacy of balloon septostomy was not related to the approach used, with 4 of 7 in Group I and 9 of 13 in Group II with an adequate atrial tear and clinical response. The Delay time to septostomy (i.e. time elapsed from initial assessment to commencement of balloon septostomy) and Procedure time (i.e. time taken to complete the balloon septostomy) was significantly shorter for Group I (mean time = 0.7 hours and 0.26 hours respectively) compared with Group IIA (mean time = 2.6 hours and 1.8 hours) and Group IIB (mean time = 2.4 hours and 1.4 hours). Of note, there was no significant increase in Delay time between Group IIA and IIB.(ABSTRACT TRUNCATED AT 250 WORDS)     

A new low profile balloon atrial septostomy catheter: initial animal and clinical experience

OBJECTIVE: To evaluate the safety and efficacy of a new low profile balloon septostomy catheter in neonatal animals as well as in one newborn infant. BACKGROUND: Balloon atrial septostomy remains one of the most commonly performed palliative procedures in pediatric cardiology. The currently available septostomy catheter requires a large introducer sheath (6 or 7F), does not have an end hole for confirmation of position or pressure measurement and is limited in patients with a small left atrium due to its large balloon inflated diameter. METHODS: Four neonatal piglets (average weight 3.9 kg) underwent percutaneous balloon atrial septostomy using the new balloon catheter inflated to 1 cc via a 5F sheath in the femoral vein. Two other piglets (average weight 4.9 kg) underwent septostomy with the conventional catheter inflated to 3.5 cc via a 6 or 7F sheath in the femoral vein. All animals underwent transthoracic echocardiography pre and post septostomy. All animals were sacrificed after the procedure and the size of the atrial defect created was measured. One neonate with Taussig-Bing anomaly underwent septostomy with the new balloon catheter. RESULTS: The left atrium was entered in all piglets. It was easier to enter the left atrium with an end hole catheter which was exchanged over a wire with the septostomy catheter. Septostomy was performed with the new or conventional catheters without complications. Echocardiography demonstrated a very small patent foramen ovale prior to the procedure and a large atrial defect after septostomy. The average size of the defect created by the new catheter was 11.3 x 10 mm in diameter and 11 x 10 mm using the conventional catheter. A 10 x 10 mm atrial communication was created in the neonate. CONCLUSIONS: This study demonstrates the safety and efficacy of this new catheter. This catheter will be of potential importance in patients with a small left atrium and in small neonates with congenital heart disease requiring septostomy.     

Absent left-sided atrioventricular connexion, with right atrium connected to left ventricle: prospective diagnosis in infancy, and outcome.

Prospective echocardiographic diagnosis of absence of the left atrioventricular connexion, with the right atrium connected to a morphologic left ventricle through a bileaflet morphologically mitral valve, was made in six infants. The rudimentary right ventricle was left-sided in all patients, and separated from the left atrium by sulcus tissue. The ventriculoarterial connexions were discordant. Associated defects included subpulmonary stenosis (2 patients), pulmonary atresia (1 patient), and a patent duct (4 patients). All patients developed early left atrial hypertension due to a restrictive interatrial septum, and required transcatheter septostomy (5 patients), or surgical septectomy (3 patients). One patient who had a severely restrictive ventricular septal defect died following cardiac catheterization. In three others the ventricular septal defect has become progressively restrictive on serial catheterization. Successful intermediate term palliation has been performed in two patients using a bidirectional Glenn anastomosis, together with enlargement of the ventricular septal defect and a Damus-Kay-Stansel procedure in one. It is possible to distinguish this malformation from "mitral atresia" using cross-sectional echocardiography. The long-term outlook is influenced by early relief of left atrial hypertension. Balloon atrial septostomy alone is usually inadequate, and either blade septostomy or surgical septectomy are required. Serial cardiac catheterization is mandatory for planning definitive palliation.     

Creation and maintenance of an adequate interatrial communication in left atrioventricular valve atresia or stenosis

Patients with left atrioventricular (AV) valve atresia or stenosis were studied retrospectively to determine the incidence of early and late failures of procedures to enlarge an interatrial communication. The 61 patients underwent 80 procedures: 5 balloon atrial septostomies, 12 blade atrial septostomies and 63 surgical septectomies. No balloon septostomy provided adequate long-term palliation. Of 12 blade septostomies, 4 resulted in gradients across the atrial septum of 5 to 8 mm Hg and 8 in gradients 3 mm Hg or less. Results from blade septostomy were unrelated to underlying diagnosis, age, gradient before the procedure, number of previous procedures, pulmonary blood flow or size of the postprocedure defect by balloon sizing, but were related to size of the postoperative defect estimated by echocardiography. Among 8 patients with gradients of 3 mm Hg or less after blade septostomy, 7 were followed 9 +/- 7 months and showed no evidence of restenosis. Of 63 surgical septectomies, 11 (17.5%) were inadequate, and in at least 7 cases the failure was due to restenosis of the defect as documented by serial catheterizations or echocardiograms. Outcome after surgical septectomy was unrelated to underlying diagnosis, age or number of previous procedures, but was related to size of the defect created. Our results reveal improved results in terms of residual gradient for blade septostomy compared with previous studies and the need to follow these patients carefully, even those undergoing surgical septectomy.     

Blade auricular septostomy

We describe the first case of BAS in our country in a three months old child with transposition of the great arteries, restrictive atrial septal defect (RASD) and intact interventricular septum. When he was 15 days old, we performed a balloon atrial septostomy. He had temporal improvement and six weeks later his cyanosis increased, and a new catheterization showed systemic arterial oxygen saturation of 30%, RASD and an interatrial pressure gradient of 2.1 mmHg (left atrium LA: 3.9 and right atrium RA: 1.8). We decided to perform a new septostomy with Park's blade atrial septostomy catheter. After the procedure the interatrial pressure gradient decreased to 0.2 mmHg (RA: 4.3 and LA: 4.5), the angiography shunt and atrial pressures increased. Five months later the child is alive and the systemic arterial oxygen saturation is 51.3%. The technique, advantages and complications are described.     

血管外科技术在胸部肿瘤外科中的应用

目的　探讨上腔静脉及无名静脉切除 ,人工血管置换术在胸部肿瘤外科治疗中的应用及其临床效果。方法　实验研究 :健康成年犬 18只 ,分为单纯阻断组 :阻断上腔静脉或上腔静脉奇静脉联合阻断 (9只 ) ;人工血管置换组 :切除上腔静脉 ,行人工血管置换 (9只 )。对上腔静脉阻断前后上腔静脉压力的变化、人工血管置换后的病理改变、抗凝治疗及长时间阻断上腔静脉后脑组织的病理改变进行分析。临床研究 :胸部肿瘤患者 56例 ,其中肺癌 42例 ,纵隔肿瘤 14例。行肿瘤根治切除术及受侵上腔静脉和 (或 )无名静脉切除人工血管置换 ,并对患者进行长期随访。结果　实验研究 :实验犬上腔静脉加奇静脉阻断后 ,上腔静脉系统压力为 (49 2 8± 14 72 )cmH2 O(1cmH2 O =0 0 98kPa) ,高于单纯上腔静脉阻断的 (3 7 83± 1 3 5)cmH2 O (P <0 0 5) ;腔静脉阻断 2h未见脑实质充血及水肿 ;人工血管置换组犬术后 1个月血管腔内壁已有纤维素沉积 ,2个月始有部分血管内皮细胞移行覆盖 ;未应用抗凝治疗情况下血管无附壁血栓形成。临床研究 :全组患者无围手术期死亡及术后近、远期上腔静脉系统梗阻症状。肺癌组患者 1、3、5年生存率分别为 84%、41%、3 9% ;纵隔肿瘤患者术后 1例死亡。结论　血管外科技术的应用 ,扩大了胸部肿瘤外科手     

Should we standardise the pre-operative management of babies with complete transposition?

BACKGROUND: Complete transposition is the most common form of neonatal cyanotic heart disease. The management of this condition has changed markedly in the last decade and there appears to be a significant variation between centres in terms of pre-operative management. OBJECTIVES/METHODS: We surveyed all paediatric cardiac surgical centres in the United Kingdom regarding pre-operative management, particularly performance and timing of balloon atrial septostomy and aortogram, imaging techniques used and discharge prior to surgery. RESULTS: There is significant variation in pre-operative management: 10 centres now perform septostomy outside the catheter lab and 11 without general anaesthesia. Eight centres use echo control only and only 3 perform routine aortograms. Three centres do not perform routine septostomy. The most common age for arterial switch was at 1-2 weeks, but some routinely performed this procedure up to 1 month of age and others aim for arterial switch before one week of age. Only 3 centres routinely discharge patients between septostomy and switch. CONCLUSIONS: Despite a trend towards echo guided septostomy and earlier arterial switch there is still considerable variation in early management of patients with transposition of the great arteries. Debate within the profession leading to a more standardised pre-operative management strategy would protect both the patient and the doctor involved in the care of children with complete transposition.     

Balloon atrial septostomy under two-dimensional echocardiographic control

We report our experience with balloon atrial septostomy under two-dimensional echocardiographic guidance only in 44 newborn patients (39 patients with transposition of the great arteries) who needed creation of an interatrial communication. Using standard echocardiographic projections septostomy with creation of large atrial septal defects was easy in 41 newborns. In 3 patients insertion of a large Eustachian valve at the interatrial septum prevented adequate pull-throughs with larger balloon sizes. No serious complications due to the procedure were noted. Balloon atrial septostomy under two-dimensional echocardiographic control is a quick, effective and safe method which can be performed on the intensive care unit.     

Balloon atrioseptostomy in 2-dimensional echocardiography

Two-dimensional echocardiography allows complete evaluation of transposition of the great arteries including additional malformations. Pressure recordings and oxymetry are without indicative value in sick and hypoxic neonates and cardiac catheterization is therefore merely therapeutic (balloon atrial septostomy). In addition balloon atrial septostomy can be performed under echocardiographic control only. This procedure saves time and costs, avoids the risks of X-ray exposure and angiocardiography and can safely be performed in the pediatric intensive care unit. Five newborn babies with transposition of the great arteries were treated with this method.     

Atrial septostomy for pulmonary hypertension

Atrial septostomy represents an additional, promising strategy in the treatment of severe PPH. Experience with this procedure still is limited; however, based on analyses of the worldwide experience, several general conclusions and recommendations can be made. 1. Atrial septostomy can be performed successfully in selected patients with advanced pulmonary vascular disease. 2. Patients with primary pulmonary hypertension who have undergone successful AS have shown: a significant clinical improvement beneficial and long-lasting hemodynamic effects at rest a trend toward improved survival 3. The procedure-related mortality of the collective experience is high (16%). Several recommendations can be made to minimize the risk: [figure: see text] Atrial septostomy should be attempted only in institutions with an established track record in the treatment of advanced pulmonary hypertension, where septostomy is performed with low morbidity. Atrial septostomy should not be performed in patients in whom death is impending or who have severe right ventricular failure and are on maximal cardiorespiratory support. An mRAP greater than 20 mm Hg, PVR index greater than 55 u/m2, and a predicted 1-year survival less than 40% are significant predictors of procedure-related death. Before cardiac catheterization, patients should have an acceptable baseline systemic oxygen saturation (> 90% in room air) and optimized cardiac function (adequate right heart filling pressure, additional inotropic support if necessary). During cardiac catheterization, the following are mandatory: Supplemental oxygen Mild sedation to prevent anxiety Careful monitoring of variables (left atrial pressure, SaO2, and mRAP) Step by step procedure After AS, it is important to optimize oxygen delivery. Transfusion of packed red blood cells or erythropoietin (before and following the procedure, if needed) may be necessary to increase oxygen content. 4. Because the disease process in PPH is unaffected by the procedure (late deaths), the long-term effects of an AS must be considered to be palliative. 5. Despite its risk, AS may represent a viable alternative for selected patients with severe PPH. Indications for the procedure may include: Recurrent syncope or right ventricular failure, despite maximal medical therapy, including oral calcium-channel blockers or continuous intravenous prostacyclin (Fig. 11) As a bridge to transplantation When no other option exists.