Noninvasive creation of an atrial septal defect by histotripsy in a canine model.
Noninvasive creation of an atrial septal defect by histotripsy in a canine model.
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DOI：
10.1161/circulationaha.109.889071
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发表时间：
2010-02-16
期刊：
影响因子：
37.8
通讯作者：
Ludomirsky A
中科院分区：
文献类型：
--
作者：
Xu Z;Owens G;Gordon D;Cain C;Ludomirsky A
主要目的是开发一种图像引导，无创的程序来创建或扩大房间隔缺损（ASD）的治疗新生儿左心发育不全综合征（HLHS）和完整或限制性房间隔。组织切片法是一种创新的超声技术，使用高强度超声脉冲产生非热的机械组织分离。本文报道了利用心脏外应用组织切片法在开胸犬模型中创建ASD的实验性体内研究。在10只犬中，通过放置在心脏外的超声换能器对房间隔进行组织学检查。采用1MHz聚焦换能器，在峰值负压为15 MPa、脉冲重复频率为3.3 kHz的条件下，产生持续时间为6μs的超声脉冲。手术过程由实时超声成像指导和监测。在10只犬中，有9只犬产生了ASD，并且可以看到房间隔分流。心脏病理显示asd对周围组织的损害很小。心外膜表面或其他结构未见损伤。在实时超声引导下，在活犬模型上成功地建立了asd。虽然需要在完整的动物模型中进行进一步的研究，但这些结果为组织切片术成为一种有价值的临床工具提供了希望。
The primary objective is to develop an image-guided, non-invasive procedure to create or enlarge an atrial septum defect (ASD) for the treatment of neonates with Hypoplastic Left Heart Syndrome (HLHS) and an intact or restrictive atrial septum. Histotripsy is an innovative ultrasonic technique that produces non-thermal, mechanical tissue fractionation using high intensity ultrasound pulses. This paper reports the pilot in vivo study to create an ASD using extracardiac application of histotripsy in an open chest, canine model. In ten canines, the atrial septum was exposed to histotripsy by an ultrasound transducer positioned outside the heart. Ultrasound pulses of 6μs duration at a peak negative pressure of 15 MPa and a pulse repetition frequency of 3.3 kHz were generated by a 1MHz focused transducer. The procedure was guided and monitored by real-time ultrasound imaging. In nine of ten canines, an ASD was produced and shunting across the atrial septum was visualized. Pathology of the hearts showed ASDs with minimal damage to surrounding tissue. No damage was found on the epicardial surface of the heart or other structures. Under real-time ultrasound guidance, ASDs were successfully created using extracardiac histotripsy in a live canine model. Although further studies in an intact animal model are needed, these results provide promise of histotripsy becoming a valuable clinical tool.