经右心房小切口建立山羊三尖瓣反流模型

Establishment of tricuspid regurgitation via right anterior-lateral minimal incision in goats model

目的采用经右房途径三尖瓣腱索切割的方法建立山羊三尖瓣反流模型。方法使用自行研制的三尖瓣腱索切割器在6只山羊中建立三尖瓣反流模型。山羊左侧卧位,经右侧第4肋间小切口进胸,在经食管超声及数字减影血管造影引导下,切割三尖瓣前瓣叶腱索从而出现中-重度反流。在术前、术后即刻、术后3个月行超声心动图等相关检查,并在3个月后行安乐死解剖明确病理改变。结果三尖瓣反流在6只山羊中成功建立,术后即刻右心房压力明显增加(P<0.05)。随访3个月,三尖瓣关闭不全进行性加重(P<0.05),三尖瓣瓣环直径由(2.15±0.23)cm增加至(2.65±0.20)cm,跨瓣压差及流速较术前差异无统计学意义,实验室检查结果与术前无异常。尸检提示前瓣叶腱索明显断裂。结论经导管右侧肋间小切口建立三尖瓣反流模型可行,为后期研究介入三尖瓣装置、三尖瓣反流模型的病理生理研究奠定了基础。

Objective To explore the feasibility of goat tricuspid regurgitation(TR)model by one chordae tendineae cutter via right anterior-lateral minimal incision.Methods TR model was established in 6 goats with a self-made tricuspid valve chordae tendineae cutter.The goats were placed in a left lateral position and procedure was performed via a right anterior-lateral minimal thoracotomy in the fourth intercostal.Under the guidance of transesophageal ultrasound and digital subtraction angiography,the chordae tendineae of anterior leaflet was cut until moderate to severe regurgitation was confirmed.Echocardiography and laboratory examinations were performed preoperatively,immediately and 3 months after surgery.Additionally,all goats were sacrificed to clarify pathological evaluation.Results TR was successfully established in 6 goats.The right atrium pressure increased significantly immediately after surgery(P<0.05).During a follow-up of 3 months,the progression of TR was aggravated(P<0.05),and the annular diameter increased from 2.15±0.23 cm to 2.65±0.20 cm.Overall,there was no statistically significant change in transvalvular gradient and velocity between preoperation and postoperation.Laboratory test results showed no abnormalities between preoperation and postoperation.Autopsy evaluation demonstrated obvioue chordae tendineae transection of the anterior leaflet.Conclusion It is feasible to establish TR model via a right minimal anterior lateral thoracotomy in the fourth intercostal space.This novel TR goats model will allow investigation of transcatheter interventional device and serve as a chronic model in the future.