Transmyocardial laser revascularization fails to prevent left ventricular functional deterioration and aneurysm formation after acute myocardial infarction in sheep.
Transmyocardial laser revascularization fails to prevent left ventricular functional deterioration and aneurysm formation after acute myocardial infarction in sheep.
复制标题
经心肌激光血运重建术不能预防绵羊急性心肌梗塞后左心室功能恶化和动脉瘤形成。
DOI：
10.1016/s0022-5223(98)00439-5
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
Bridges,CR
中科院分区：
文献类型：
--
作者：
Malekan,R;Kelley,ST;Suzuki,Y;Reynolds,C;Plappert,T;Sutton,MS;EdmundsJr,LH;Bridges,CR
目的探讨经心肌激光血管重建术对不能手术的冠状动脉疾病患者缺血心肌血管重建术的疗效。本研究验证了激光血运重建术预防急性心梗后左室功能恶化和动脉瘤形成的假设。方法在26只多塞特杂交绵羊左前降支和第二斜支远端冠状动脉周围放置超声升主动脉血流探头和陷阱。10 ~ 14天后，被困的动脉被阻塞，造成23%左心室肿块的根尖前梗死。在梗死前，14只动物在预期梗死区域用二氧化碳激光穿孔34±4个。12只动物作为对照。血流动力学测量和经膈定量超声心动图分别在梗死前、后、2周、5周和8周进行。18只羊完成了实验。结果所有动物均有较大的左心室前根尖动脉瘤，并发大量心室增大。梗死后，所有羊的前壁立即变薄，运动障碍。8周时，两组之间的动脉瘤大小和形状无法区分。梗塞后2天，用纤维蛋白填充激光孔。在第5周和第8周时，梗死灶由致密的胶原蛋白、成纤维细胞、分散的钙化、肌细胞碎片、中性粒细胞、巨噬细胞组成，无激光空洞。在任何时候，两组之间的心脏压力或输出量、心室容积、射血分数、卒中功和卒中功-左心室舒张末期压指数均无显著差异。结论经心肌激光穿孔对绵羊急性心肌梗死无血运重建作用。[J]; chinese journal of nurses training; 1998; 16: 562 - 562。
ObjectiveTransmyocardial laser revascularization is an investigational technique for revascularizing ischemic myocardium in patients with inoperable coronary arterial disease. This study tests the hypothesis that laser revascularization prevents left ventricular functional deterioration and aneurysm formation after acute anteroapical myocardial infarction.MethodsAn ultrasonic ascending aortic flow probe and snares around the distal left anterior descending and second diagonal coronary arteries were placed in 26 Dorsett hybrid sheep. Ten to 14 days later, snared arteries were occluded to produce an anteroapical infarction of 23% of left ventricular mass. Before infarction 14 animals had 34 ± 4 transmyocardial perforations in the area of the anticipated infarction made with a carbon dioxide laser. Twelve animals served as controls. Hemodynamic measurements and transdiaphragmatic quantitative echocardiograms were obtained before, immediately after, and 2, 5, and 8 weeks after infarction. Eighteen sheep completed the protocol.ResultsAll animals had large anteroapical left ventricular aneurysms with massive ventricular enlargement. Immediately after infarction the anterior wall became thinner and dyskinetic in all sheep. At 8 weeks aneurysmal size and shape were indistinguishable between groups. Two days after infarction, laser holes were filled with fibrin. At 5 and 8 weeks the infarct consisted of dense collagen, fibroblasts, scattered calcifications, myocyte fragments, neutrophils, macrophages, and no laser holes. There were no significant differences at any time between groups for cardiac pressures or output, ventricular volumes, ejection fraction, stroke work, and the stroke work–left ventricular end-diastolic pressure index.ConclusionTransmyocardial laser perforations do not revascularize acute myocardial infarction in sheep. (J Thorac Cardiovasc Surg 1998;116:752-62)