Nazarian Saman, Knight Bradley P, Dickfeld Timm L, Zviman Menekhem M, Jayanti Venku B, Amundson David, Hanlin John, Castleberry Jeffrey, Smith Mark F, Blankenship Larry, Halperin Henry R, Ferguson T Bruce, Berger Ronald D
Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Heart Rhythm. 2005 Aug;2(8):844-8. doi: 10.1016/j.hrthm.2005.04.020.
Placement of electrophysiology catheters and pacing leads in the coronary sinus is challenging in some patients, particularly those with dilated cardiomyopathy. We hypothesized that cannulation of the coronary sinus and its branches can be facilitated by direct visualization. This study reports our experience with navigation into and within the coronary sinus in a closed-chest animal preparation, using a flexible steerable fiberoptic infrared endoscope that allows visualization through flowing blood.
The purpose of this study was to assess the feasibility of direct visualization of endocardial structures through infrared endoscopy.
Internal jugular venous access was obtained in 10 healthy mongrel dogs (weight 35-45 kg). The infrared endoscope (2900 fiber imaging bundle, wavelength 1,620 nm, frame rate 10-30/s, 320 x 256 pixels) was advanced to the coronary sinus ostium and branches by direct visualization of anatomic landmarks, such as the tricuspid valve and inferior vena cava. Localization was confirmed by fluoroscopy, contrast injection, and pathologic examination.
Structures such as the tricuspid valve and inferior vena cava were visualized at distances of 1 to 2 cm, allowing successful coronary sinus identification and engagement in all 10 dogs. Coronary sinus branch images closely resembled pathologic findings.
Direct visualization of the coronary sinus ostium and branches is possible through infrared endoscopy. This technique likely will facilitate coronary sinus engagement and navigation for pacing lead and catheter placement.
在一些患者中，尤其是患有扩张型心肌病的患者，将电生理导管和起搏导线放置于冠状静脉窦具有挑战性。我们推测，通过直接可视化可便于对冠状静脉窦及其分支进行插管。本研究报告了我们在闭式胸腔动物模型中使用可灵活操控的光纤红外内窥镜进入冠状静脉窦并在其中进行导航的经验，该内窥镜可透过流动的血液进行可视化观察。
本研究的目的是评估通过红外内窥镜直接可视化心内膜结构的可行性。
对10只健康杂种犬（体重35 - 45千克）进行颈内静脉穿刺置管。通过直接观察诸如三尖瓣和下腔静脉等解剖标志，将红外内窥镜（2900光纤成像束，波长1620纳米，帧率10 - 30帧/秒，320×256像素）推进至冠状静脉窦口及其分支。通过荧光透视、造影剂注射和病理检查来确认定位。
在距离1至2厘米处可观察到三尖瓣和下腔静脉等结构，从而在所有10只犬中成功识别并进入冠状静脉窦。冠状静脉窦分支的图像与病理结果非常相似。
通过红外内窥镜可直接可视化冠状静脉窦口及其分支。该技术可能会便于冠状静脉窦的进入以及起搏导线和导管放置的导航操作。
