Left-sided atrial flutter: characterization of a novel complication of pediatric lung transplantation in an acute canine model.
Left-sided atrial flutter: characterization of a novel complication of pediatric lung transplantation in an acute canine model.
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左侧心房扑动：急性犬模型中小儿肺移植的新并发症的特征。
DOI：
10.1016/s0022-5223(96)70100-9
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Huddleston,CB
中科院分区：
文献类型：
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作者：
Gandhi,SK;Bromberg,BI;Schuessler,RB;Boineau,JP;Cox,JL;Huddleston,CB
背景在我院接受肺移植的儿童中，约有10%发生术后房扑。我们假设，左心房缝合，以建立肺静脉连续性提供了主要的电生理substrates为atrial flutter.ObjectivesOur的目标是（1），以确定是否左心房缝合线单独是足以产生心房扑动在急性犬肺移植模型和（2）。表征任何由此产生的折返回路手术消融atrial flutter.MethodsSupported心肺转流，成年犬（n = 10）进行了双侧肺切除术。通过分割横断的上级和下级肺静脉口之间的组织并闭合产生的缺损来模拟左心房吻合缝合线。组1（n = 6）放置双侧缝合线以模拟双侧肺移植。在第2组（n = 4）中，仅放置左侧缝合线以代表单肺移植。通过双侧心室切开术插入单极253点双房心内膜标测电极。心房短阵起搏诱发心房扑动，生成激动序列标测图。在第1组的6个病例中，有5个病例随后制作了连接两条缝合线和二尖瓣环的T形切口。在第2组中，每例病例均从缝合线至二尖瓣环进行单切口。随后重复Burst pacing。ResultsAtrial扑动不能诱导后，旁路单独在任何情况下。模拟肺移植后，10只犬中有10只可重复诱导持续性房扑。所有犬的平均周期长度为133 ± 7 msec。第1组和第2组之间的平均周期长度或激活序列模式无显著差异。折返环局限于左心房。每个模拟的左心房吻合都产生了一个传导阻滞区，周围可能发生环形运动。在第1组中，任一缝合线均起中心障碍作用。结论（1）在急性肺移植犬模型中，左心房缝合线单独形成一个传导阻滞区，周围可发生环状运动，从而为心房扑动提供电生理基础。(2)将该阻滞区延伸至二尖瓣环，并中断双侧肺移植后两条缝合线之间的组织峡部，可终止该模型中的房扑，并可能在儿童肺移植时用于预防术后房扑。（《胸血管外科杂志》1996;112：992-1001）
BackgroundPostoperative atrial flutter has been observed in approximately 10% of children undergoing lung transplantation at our institution. We hypothesized that the left atrial anastomoses made to establish pulmonary venous continuity provide the primary electrophysiologic substrates for atrial flutter.ObjectivesOur objectives were (1) to determine whether the left atrial suture lines alone are sufficient to produce atrial flutter in an acute canine model of lung transplantation and (2) to characterize any resulting reentrant circuits to surgically ablate the atrial flutter.MethodsSupported by cardiopulmonary bypass, adult dogs (n = 10) underwent bilateral pneumonectomies. The left atrial anastomotic suture lines were simulated by dividing the tissue between the ostia of the transected superior and inferior pulmonary veins and closing the resulting defects. Bilateral suture lines were placed in group 1 (n = 6) to simulate bilateral lung transplantation. In group 2 (n = 4), only a left-sided suture line was placed to represent single lung transplantation. Unipolar 253-point biatrial endocardial mapping electrodes were inserted via bilateral ventriculotomies. Atrial flutter was induced by atrial burst pacing, and activation sequence maps were generated. In five of six cases in group 1, a T-incision connecting the two suture lines and the mitral anulus was then made. In group 2, a single incision from the suture line to the mitral anulus was performed in each case. Burst pacing was subsequently repeated.ResultsAtrial flutter could not be induced after bypass alone in any case. After simulated lung transplantation, sustained atrial flutter was reproducibly induced in 10 of 10 dogs. The mean cycle length in all dogs was 133 ± 7 msec. There was no significant difference in mean cycle length or activation sequence patterns between groups 1 and 2. The reentrant circuit was confined to the left atrium. Each simulated left atrial anastomosis created a zone of conduction block around which circus movement could occur. In group 1, either suture line functioned as the central obstacle. Atrial flutter was terminated in five of five dogs in group 1 by means of the T-incision and in all four dogs in group 2 with the incision connecting the suture line to the mitral anulus.Conclusions(1) In an acute canine model of lung transplantation, each left atrial suture line alone provides an electrophysiologic substrate for atrial flutter by creating a zone of conduction block around which circus movement can occur. (2) Extending this zone of block to the mitral anulus, together with interruption of the isthmus of tissue between the two suture linespresent after bilateral lung transplantation, terminates the atrial flutter in this model and may have an application prophylactically at the time of lung transplantation in children to prevent postoperative atrial flutter. (J Thorac Cardiovasc Surg 1996;112:992-1001)