OTW型三腔双球囊导管在心肌梗死致室间隔穿孔的急性期治疗中的应用研究

急性心肌梗死致室间隔穿孔是较少见的危重症，其死亡率９０％。外科修补穿孔因创伤大而死亡率高。记忆金属封堵伞也因较僵硬，并不适合脆弱的心肌，故急性期的应用受限制。我们设想用柔软的乳胶球囊阻断室间隔穿孔的分流，作为过渡性治疗。在重庆市科委的支持下，我们研发出球囊导管并在猪体内中初步验证了有效性。目前改良设计出第二代导管，即经导丝输送型（over the wire，OTW）三腔双乳胶球囊导管，预实验中采用0.014”导丝可引导到位，充盈后形成哑铃状，阻断分流。我们拟在心肌梗死合并室间隔穿孔的猪模型，进一步验证其可行性和有效性，探索不同强度的球囊对心肌瘢痕修复的影响，观察瓣膜损伤情况，验证利伐沙班对球囊相关血栓的预防作用。并采用梗死后心肌的核磁共振的变化作为标准，探索同时期的局部心肌运动（采用心脏超声的斑点追踪法）和血浆中结缔组织生长因子、BNP等浓度的变化规律，为二次手术的时机评估提供简易方法。

Interventricular septal perforation caused by acute myocardial infarction is a rare critical condition, with a mortality rate of about 90%. Surgical repair has a high mortality rate due to large trauma. Interventional therapy with occlusion parachute is also limited useful in acute stage because it is stiff and not suitable for edema and fragile myocardium. In order to solve the treatment problem in the acute stage, the over the wire（OTW） type three-lumen double-lumen double latex balloon catheter was designed by our group. After placing two balloons at the perforation, the inflated balloon can block the abnormal blood flow at the perforation and help the patient survive through the acute phase. The pig model of anterior wall myocardial infarction complicated with interventricular septal perforation was used to verify the feasibility and effectiveness of this balloon catheter in blocking the perforation, to explore the effect of different intensity balloons on myocardial scar repair, and to observe valve injury. to verify the preventive effect of rivasaban on balloon-related thrombus. The changes of myocardial MRI after infarction were used as the standard to explore the changes of regional myocardial movement (using the spot tracking method of cardiac ultrasound) and the concentration of connective tissue growth factor (CTGF) in plasma in the same period. to provide a theoretical basis for the timing of the second operation in the recovery period.