Transthoracic delivery of large devices into the left ventricle through the right ventricle and interventricular septum: preclinical feasibility.
Transthoracic delivery of large devices into the left ventricle through the right ventricle and interventricular septum: preclinical feasibility.
复制标题
大型设备通过右心室和室内隔膜转移到左心室：临床前的可行性。
DOI：
10.1186/1532-429x-15-10
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发表时间：
2013-01-18
期刊：
影响因子：
--
通讯作者：
Lederman RJ
中科院分区：
文献类型：
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作者：
Halabi M;Ratnayaka K;Faranesh AZ;Hansen MS;Barbash IM;Eckhaus MA;Wilson JR;Chen MY;Slack MC;Kocaturk O;Schenke WH;Wright VJ;Lederman RJ
我们的目标是将大型器具通过右心室并穿过室间隔输送到左心室。这种经胸腔通路利用了隔膜的立即反冲，以及穿过右心室游离壁的跨心肌压力梯度比左心室游离壁更低。该路线可以增强安全性并允许剑突下而不是肋间穿越。整个过程是在实时 CMR 指导下进行的。 “主动”CMR 针穿过胸部、右心室游离壁，然后穿过室间隔以输送导丝，然后用于输送 18Fr 导引器。然后，用镍钛诺封堵器封闭右心室游离壁。未修复的隔膜和游离壁的立即闭合和晚期愈合通过血氧饱和度、血管造影、CMR 和长达 4 周的尸检进行评估。 11 头猪中有 9 头的手术取得了成功。一种失败是因为进针时难治性心室颤动，另一种是因为导丝支撑不足。在所有十次尝试中，右心室游离壁均被关闭，且没有心包积血。血氧测定、X 射线血管造影或 CMR 均未发现立即或晚期分流。室间隔完全纤维化。人体 CT 扫描计划的经心室轨迹表明，与传统的房间隔入路相比，腔内工作空间可比，进入角度更小。大型闭胸进入口可穿过右心室游离壁和室间隔引入左心室。隔膜立即回缩并完全愈合，无需修复。镍钛诺封堵器立即密封右心室壁。例如，与传统的房间隔入路相比，该进入角更有利于引入人工二尖瓣。
We aim to deliver large appliances into the left ventricle through the right ventricle and across the interventricular septum. This transthoracic access route exploits immediate recoil of the septum, and lower transmyocardial pressure gradient across the right versus left ventricular free wall. The route may enhance safety and allow subxiphoid rather than intercostal traversal. The entire procedure was performed under real-time CMR guidance. An “active” CMR needle crossed the chest, right ventricular free wall, and then the interventricular septum to deliver a guidewire then used to deliver an 18Fr introducer. Afterwards, the right ventricular free wall was closed with a nitinol occluder. Immediate closure and late healing of the unrepaired septum and free wall were assessed by oximetry, angiography, CMR, and necropsy up to four weeks afterwards. The procedure was successful in 9 of 11 pigs. One failed because of refractory ventricular fibrillation upon needle entry, and the other because of inadequate guidewire support. In all ten attempts, the right ventricular free wall was closed without hemopericardium. There was neither immediate nor late shunt on oximetry, X-ray angiography, or CMR. The interventricular septal tract fibrosed completely. Transventricular trajectories planned on human CT scans suggest comparable intracavitary working space and less acute entry angles than a conventional atrial transseptal approach. Large closed-chest access ports can be introduced across the right ventricular free wall and interventricular septum into the left ventricle. The septum recoils immediately and heals completely without repair. A nitinol occluder immediately seals the right ventricular wall. The entry angle is more favorable to introduce, for example, prosthetic mitral valves than a conventional atrial transseptal approach.