Rothman A, Ricou F, Weintraub R G, Crowley R, Arcangeli R, Shiota T, Zhang J, Sahn D J
Division of Pediatric Cardiology, University of California San Diego.
Circulation. 1992 Jun;85(6):2291-5. doi: 10.1161/01.cir.85.6.2291.
Controversy still exists over the optimal balloon size, extent of vascular disruption, and long-term results of balloon dilation therapy for coarctation of the aorta. Intravascular ultrasound imaging has been used in patients with coronary artery disease to provide further insight into the anatomy of atherosclerotic lesions and the results of angioplasty and atherectomy. Initial observations of the results of balloon dilation of coarctations with intravascular ultrasound imaging have shown prominent dissections of the inner vascular layers that are often not detected by angiography. The purpose of this study was to test a new transballoon catheter ultrasonic imaging system capable of on-line direct visualization of lumen diameter and vessel wall structure for imaging before, during, and after dilation in an acute animal model of aortic coarctation.
Abdominal aortic coarctations were created surgically in three 14-19-kg mongrel dogs by using Teflon gauze ties. The 6.8F ultrasound balloon catheter was placed percutaneously in the right femoral artery through a 9F sheath. Ultrasound imaging allowed measurement of the coarctation diameter, characterization of the vessel wall structure, localization of the stenosis, and placement of the midportion of the balloon at the narrowest area. Imaging through the balloon was performed through several dilations (five to eight per animal), and after balloon deflation, it provided information on postdilation diameter, intimal tears, long-segment dissections, and intramural thrombi, findings that were confirmed at postmortem examination.
The results of this study demonstrate that imaging with a new intraballoon ultrasound device is feasible during inflation to therapeutic dilation pressures; it allows visualization of the changes in diameter and vascular wall structure after serial dilations without having to recross the obstructed area. Adaptation to larger balloon sizes and lower frequencies should make this system applicable to interventional catheterizations in patients with congenital cardiac and vascular lesions.
对于主动脉缩窄球囊扩张治疗的最佳球囊尺寸、血管破坏程度及长期效果仍存在争议。血管内超声成像已应用于冠状动脉疾病患者，以更深入了解动脉粥样硬化病变的解剖结构以及血管成形术和旋切术的效果。血管内超声成像对主动脉缩窄球囊扩张结果的初步观察显示，血管内层有明显的夹层，而血管造影术常常无法检测到这些夹层。本研究的目的是在急性主动脉缩窄动物模型中，测试一种新型的经球囊导管超声成像系统，该系统能够在扩张前、扩张过程中和扩张后在线直接观察管腔直径和血管壁结构。
通过使用特氟龙纱布扎带，对3只体重14 - 19千克的杂种犬进行手术，制造腹主动脉缩窄。将6.8F超声球囊导管经皮通过9F鞘管置于右股动脉。超声成像可测量缩窄直径、表征血管壁结构、定位狭窄部位，并将球囊中部置于最狭窄区域。通过球囊进行多次扩张成像（每只动物进行5至8次），球囊放气后，可提供扩张后直径、内膜撕裂、长段夹层和壁内血栓的信息，这些结果在尸检时得到证实。
本研究结果表明，在充气至治疗扩张压力期间，使用新型球囊内超声装置成像可行；它允许在连续扩张后观察直径和血管壁结构的变化，而无需再次穿过梗阻区域。适应更大的球囊尺寸和更低的频率应使该系统适用于先天性心脏和血管病变患者的介入导管治疗。
