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目的:比较采用经皮室间隔心肌化学消融术(PTSMA)和经皮室间隔隧道心肌化学消融术(PTSTMA)干预不同冠状动脉间隔支血管对犬心脏功能的影响。方法:普通杂种犬25只,根据冠状动脉造影结果分为两组:PTSMA组(n=13)为第一间隔支较粗大行PTSMA;PTSTMA组(n=12)为室间隔细小或分布不均需行PTSTMA。制备心肌化学消融模型,记录术前、术后的体表心电图、心肌损伤标记物、超声心动图和血流动力学的变化。术后1周处死,苏木素—伊红(HE)染色和马松(Masson)染色观察室间隔心肌的病理学变化。结果:两组化学消融均可引起的心肌坏死,室间隔厚度减少。但左心室舒张末内径、左心室射血分数和血流动力学指标差异无统计学意义。两组相比术中使用的酒精量、心电图的改变及超声心动图和血流动力学变化差异均无统计学意义(P>0.05)。病理学显示心肌化学消融灶与正常心肌细胞间界限明显,交界区中性粒细胞浸润,梗死区细胞部分呈“鬼影细胞”样改变,逐渐由纤维组织所取代。消融的间隔支管腔内可见团块样坏死物质,血管正常管壁结构消失。PTSMA组血管管腔的形态仍存在,血管内坏死无仍局限在管腔内;但PTSTMA组间隔支血管的血管壁不连续,有部分坏死物移向管腔外。结论:对于不同冠状动脉间隔支血管采用“PTSMA”或“PTSTMA”不同治疗策略,均能达到有效的化学消融,且对心脏功能、血流动力学无明显影响。
OBJECTIVE: To compare the effects of percutaneous transluminal coronary angioplasty (PTSMA) and transcatheter closure tunnel myocardial chemical ablation (PTSTMA) on the cardiac function in dogs with different interventricular septum coronary arteries. Methods: 25 normal mongrel dogs were divided into two groups according to the results of coronary angiography: PTSMA group (n = 13) was the first segmental thicker PTSMA group; PTSTMA group (n = 12) was interventricular septum small or unevenly distributed Need to do PTSTMA. Preparation of myocardial chemical ablation model, preoperative and postoperative surface ECG, myocardial injury markers, echocardiography and hemodynamic changes. One week after operation, the pathological changes of ventricular septal myocardium were observed by hematoxylin-eosin (HE) staining and Masson staining. Results: Both groups were able to cause myocardial necrosis by chemical ablation, and the thickness of ventricular septum decreased. However, left ventricular end-diastolic diameter, left ventricular ejection fraction and hemodynamic parameters showed no significant difference. There were no significant differences between the two groups in the amount of alcohol used during operation, changes in electrocardiogram, echocardiographic and hemodynamic changes (P> 0.05). Pathology showed that the boundary between myocardial chemical ablation lesions and normal cardiomyocytes was obvious. Infiltration of neutrophils in the junctional area was observed. The cells in the infarction area were changed into “ghost cells” and gradually replaced by fibrous tissue. Ablation of the intercostal space visible mass necrosis of the mass, vascular wall structure disappeared. The morphology of vascular lumen in PTSMA group still exists. Intravascular necrosis is still not confined to the lumen. However, the vessel wall of PTSTMA group is not continuous and some of the necrotic material moves outside the lumen. Conclusion: Different treatment strategies of “PTSMA” or “PTSTMA” with different coronary vessels can achieve effective chemical ablation and have no significant effect on cardiac function and hemodynamics.