激光心肌血管重建术治疗心肌缺血后左室形态和功能表现

The Morphological and Functional Manifestations of Left Ventricle in Myocardlal Ischemia Treated by Laser Transmural Revascularization

作者采用钕钇铝石榴石（Ｎｄ：ＹＡＧ）激光直接心肌血管重建术观察对左室形态学和功能学的远期影响。１２只犬完全随机分力实验组（ＥＧ）和对照组（ＣＧ）。左室造影显示：ＥＧ的左室整体和局部射血分数（ＴＥＦ，ＡＥＦ）和左室短轴径缩短率（△Ｄ）均高于ＣＧ（Ｐ＜０．０５）：ＥＧ有２只犬显示左室前壁运动减弱，ＣＧ全部大显示左室前壁室壁瘤形成：左室舒张终末压（ＬＶＥＤＰ）在ＥＧ为－０．０６±０．８６ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）．在ＣＧ为０．３６±０．７３ｋＰａ（Ｐ＞０．０５）。ＳＰＥＣＴ显示：ＣＧ全部犬发生透壁性心肌梗塞，ＥＧ仅１只犬发生心内膜下心肌埂塞（Ｐ＜０．０１）。结论：左室造影和ＳＰＥＣＴ可用于检测心肌血管重建术后的效果；Ｎｄ：ＹＡＧ激光用于直接心肌血管重建术是一种有效可行的方法。

Twelve healthy mongrel dogs were divided at random into 2 groups:experiment(EG)and control(CG),6 of them were used to observe the delayed (8 months) morphological and functional changes of left ventricle in myocardial ischemia treated immediately by laser transmural revascularization. Left ventriculography showed EG exceeded CG in total and area ejection fraction(TEF, AEF),and short diameter shortening (△D)of left ventricle(P<0.05 ).2 dogs of EG showed weak pulsation of anterior wall of left ventricle. All dogs in CG revealed aneurysm of anterior wall of left ventricle. The left ventricular end diastolic pressure (LVEDP)was-0.06±0.84kPa(1kPa=7.5mmHg)in EG,and 0.36±0.75kPa in CG(P>0.05).Single photon emission computed tomography(SPECT)showed total thickness myocardial infarction in all of CG while in EG there was subendocardial infarcion in only one animal (P< 0.01).Conclusion:left ventriculography and SPECT may be used in monitoring the effect after transmural revascularization. Nd :YAG laser is an efficient method for direct transrnural revascularization.