经皮室间隔隧道化学消融术对犬室间隔心肌的影响

The pathological effects and the mechanisms of percutaneous transluminalseptal tunnel myocardial ablation in cardiomyopathy

目的：观察室间隔隧道化学消融术（PTSTMA）对室间隔心肌的影响。方法：普通杂种犬10只,随机分为对照组3只,手术组7只。手术组犬行冠脉动脉造影后,选择血管直径为1-1.5 mm的室间隔支,经OTW球囊扩张后,由OTW球囊注入无水酒精。记录体表心电图、心肌损伤标记物和心脏超声。1周后处死,HE染色和MASSON染色观察室间隔病理学变化。结果：经冠脉造影证实PTSTMA引起小室间隔支闭塞。心电图显示无水酒精注射后ST段弓背抬高。术后14-16 h肌酸激酶同工酶、肌钙蛋白Ⅰ和脑钠肽均显著性升高（均P〈0.01）。病理学显示消融灶内心肌坏死,内有少量炎症细胞浸润。心脏超声显示心脏功能及左室大小无明显影响,室间隔厚度显著减少;无室间隔穿孔、心脏破裂、附壁血栓等并发症。结论：经皮PTSTMA术对小室间隔支能达到安全、有效的消融治疗。

Objective To investigate the pathological effects and the mechanisms of percutaneous transluminalseptal tunnel myocardial ablation（PTSTMA） in cardiomyopathy in canine.Methods Ten ordinary mongrel dogs were randomly divided into;the control group and the PTSTMA group.After coronary angiography,we made a ＂ tunnel＂ of septal branch by OTW balloon in the PTSTMA group.Electrocardiograph and echocardiography were performed and recorded.Hematoxylin and eosin staining with MASSON staining further confirmed necrosis within the injection region at 1 week after operation.Results In the PTSTMA group,experimental myocardial infarction was induced by PTSTMA.Compared to normal canines,CK-MB,TNI and BNP were higher.HE staining and MASSON staining indicated that the shrunk myofibrils were replaced by connective tissue.There were necrosis and neutrophils in section of septal perforator and surrounding myocardium.LVEDd,EF were unchanged and IVSD were decreased in the PTSTMA group at 1 week.At the same time,no associated complications of ablation were detected.Conclusion PTSTMA is feasible and safe for treating cardiomyopathy in future.