一种实验犬房间隔穿刺的新方法

A new method for atrial septal puncture in canine

目的探索一种实验犬房间隔穿刺的方法。方法健康犬lO只，体质量10-15kg，麻醉后穿刺股静脉置入鞘管，经鞘管送入0．032英寸（1英寸-2．54cm）导引导丝至上腔静脉，沿导丝将房间隔穿刺鞘送人上腔静脉，退出导丝经穿刺鞘送人Brockenbrough穿刺针至鞘管内距离头端约lcIn处并指向12点钟方向，回撤鞘管及穿刺针同时顺钟向旋转针柄，至右房影中下1／s，针柄指向3点钟位置时可见到鞘管头端向左侧略明显的滑动，提示鞘管滑入卵圆窝。右前斜40°～50°透视，调整鞘管头端方向指向心影下缘上两个肋骨高度，推送鞘管有阻力后固定鞘管推送穿刺针，刺破房间隔至左心房，经穿刺针造影观察造影剂迅速弥散，或看到横行的左房顶部及左心耳确认穿刺进入左心房，固定穿刺针，推送鞘管超出穿刺针l～2mm，退出穿刺针，经鞘管推注肝素后沿置入0．032英寸左房两圈半钢丝至左房内弯曲2～3圈，固定导丝及扩张鞘，推送鞘至左房中部退出扩张鞘及导丝肝素化。术后观察30rain后复查心电图，经胸超声检查有无心包积液。处死5只实验犬观察房间隔穿刺位置，其余犬观察1个月记录并发症发生情况。结果lO只实验犬中有8只一次性穿刺成功，有2只第2次穿刺成功。1只犬因心包填塞死亡，其余犬术后30rain心电图及经胸超声检查未见异常。即刻处死的5只犬心脏大体标本均未见心包腔内血性液体，房间隔穿刺孔位于卵圆孔近似中央，其余犬观察1个月无其他并发症。手术操作时间（45±12．6）min，透视时间（9．2±6．4）min。结论利用犬固定体位下固定x线投照角度时的骨性标记定位进行房间隔穿刺的方法，操作简便、安全有效。

Objective To explore a new method for atrial septal puncture in canine.Methods Ten healthy mongrel dogs,weighing 10-15 kg,were used in the present study.Femoral venous access was obtained after anesthesia;a 0.032inch(1inch=2.54cm)guide wire and transseptal sheath were introduced into the superior vena cava(SVC).The guide wire was then withdrawn and the Brockenbrough needle was advanced to the tip of the catheter(1cm to the tip,pointing the 12o′clock direction).Under the posteroanterior view,the needle and sheath assembly were gradually withdrawn from the SVC and gently rotated clockwise into the right atrium.When reaching the lower third of the RA,the tip of catheter was slipped to the left.The entire transseptal apparatus was adjusted to 3o′clock direction to allow the tip pointing the landmark(location of the second rib above the heart shadow)in the right anterior oblique 40°-50°view.Gently push the sheath till resistance,and then the needle was manipulated to the fossa ovalis(FO)under fluoroscopy.After the location of the needle tip in the left atrium(LA)was confirmed by angiogram,the catheter was advanced over the needle to the LA.After removal of the needle,the 0.032 inch LA guide wire was introduced into the LA.The sheath assembly was advanced into LA over the guide wire.After removal of the guide wire and the dilator of sheath,a heparin bolus of 1 800-3 000(80-100units/kg)was administered.Electrocardiogram(ECG)and transthoracic echocardiography(TEE)were performed 30 min after transseptal puncture.Five dogs were sacrificed after procedure to observe the location of the puncture,and other dogs were followed up for 1 month.Results The first attempt of puncture at TS crossing was successful in 8(80%)dogs,and the second attempt was successful in 2(20%)dogs.One dog died due to pericardial tamponade.ECG and TEE showed no abnormal findings in other dogs.In the five sacrificed dogs no bloody pericardial effusion was found,and the sites of TS puncture were at the center of FO.There were no other complications in the other dogs.The fluoroscopy time was(9.2±6.4)min and the procedure time was(45±12.6)min in our study.Conclusion Our new method is safe,simple and effective to perform TS puncture under fluoroscopic guidance from fixed bony landmarks.