摘要
目的观察利用多功能心腔内超声(ICE)导管化学消融犬左心室前组乳头肌(APM)的可行性。方法将15只杂交犬随机分均为0.2 ml组、0.4 ml组及0.8 ml组,每组5只。在ICE图像定位和监控下于左心室APM基底部注射不同剂量无水乙醇进行化学消融。于消融前及消融5天后行经胸超声,检测二尖瓣反流面积(MRA)及射流紧缩口宽度(VC)。之后处死动物,观察APM大体及病理变化。结果ICE图像可清晰显示左心室APM结构,并实时监测进针深度及消融过程。消融5天后0.2 ml及0.4 ml组MRA、VC无明显改变,0.8 ml组MRA及VC较消融前明显增加(P均<0.05)。APM基底部可见中央呈苍白色的消融灶,0.2 ml、0.4 ml及0.8 ml无水乙醇在APM基底部形成的消融灶体积分别为(0.37±0.07)cm^2、(0.69±0.08)cm^2、(0.96±0.19)cm^2,较高剂量组消融灶体积均大于较低剂量组(P均<0.05)。光镜下见消融灶内心肌细胞呈不可逆性坏死改变。结论采用ICE导管注射低剂量无水乙醇可安全、有效消融左心室APM,有望为治疗左心室APM起源室性心律失常提供新的策略。
Objective To observe the feasibility of chemical ablation of left ventricular(LV)anterior papillary muscle(APM)using multifunctional intracardiac echocardiography(ICE)catheter.Methods Fifteen hybrid canines were randomly divided into 0.2 ml,0.4 ml and 0.8 ml injection groups(each n=5).Then the above doses of ethanol were injected into the base of LV APM under the location and monitoring of ICE images in each group,respectively.Mitral regurgitation area(MRA)and vena contracta(VC)were measured with transthoracic echocardiography before and 5 days after ablation.All animals were sacrificed 5 days after ablation,the general and pathological changes of APM were observed.Results ICE images clearly displayed the structure of LV APM and the depth of needle insertion and ablation process in real time.No significant difference of MRA nor VC was detected in 0.2 ml nor 0.4 ml group before and 5 days after ablation,but MRA and VC in in 0.8 ml group were both higher than those before ablation(all P<0.05).Pale ablation lesions in the base of APM were observed,the volume of ablation lesions formed by 0.2 ml,0.4 ml and 0.8 ml absolute ethanol at the base of APM were(0.37±0.07)cm^2,(0.69±0.08)cm^2 and(0.96±0.19)cm^2,respectively.The volume of ablation lesion in higher dose group was larger than that in lower dose group(all P<0.05).Irreversible necrosis of cardiomyocytes were observed in the ablation site under light microscopy.Conclusion Chemical ablation of APM is effectively and safely achieved with intramyocardial injection of small amount of ethanol,which may provide a new ablation strategy for treatment of ventricular arrhythmia originating from LV APM.
作者
钱俊
黄晶
杨刚
江永红
朱悫
刘地川
邓昌明
QIAN Jun;HUANG Jing;YANG Gang;JIANG Yonghong;ZHU Que;LIU Dichuan;DENG Changming(Department of Cardiology,the Second Affiliated Hospital of ChongqingMedical University,Chongqing 400010,China)
出处
《中国医学影像技术》
CSCD
北大核心
2020年第7期976-980,共5页
Chinese Journal of Medical Imaging Technology
