Downing S W, Llaneras M, Georgi D, Wood D C, Savage E B, Edmunds L H
Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia.
Ann Thorac Surg. 1992 Jan;53(1):132-8. doi: 10.1016/0003-4975(92)90772-v.
Two methods to cannulate the left atrium for initiating mechanical left ventricular circulatory assistance using a centrifugal pump were investigated in 25 sheep. A modified Dennis transatrial septal approach produced flow rates of 88.6 +/- 14 mL.kg-1.min-1 through 21F catheters inserted during fluoroscopy through the jugular vein. In 8 animals the septal perforation was plugged after decannulation with a modified Rashkind umbrella plug. Fibroendothelial tissue covered the plug by 4 week. In 7 other animals, the septal defect was not plugged. The septal defect reached pinpoint size by 2 weeks and was completely closed by 4 weeks. In 10 sheep, the left atrium was cannulated from the neck through the mediastinum. Left ventricular assistance flow averaged 71.6 +/- 14 mL.kg-1.min-1. Mean blood loss during 1 hour of left ventricular assistance was 47 mL. In 8 animals, the atrial perforation was plugged with a mean blood loss of 253 +/- 194 mL. In 2 animals, the perforation was intentionally not plugged; mean blood loss was 700 mL. All animals survived. The modified Dennis transatrial method is recommended as a safe, expeditious, cost-effective method to implement left ventricular assistance without thoracotomy. The mediastinal approach, which is technically possible in humans, is more difficult but feasible. Left ventricular assistance has been proven to be the most effective way to rest the failing, ejecting left ventricle. Implementation without thoracotomy potentially expands applications of left ventricular assistance for temporary support of patients with severe manifestations of ischemic heart disease.
在25只绵羊身上研究了两种使用离心泵启动机械左心室循环辅助时经皮穿刺左心房的方法。一种改良的丹尼斯经房间隔穿刺法，通过在透视引导下经颈静脉插入的21F导管，产生的血流量为88.6±14 mL·kg-1·min-1。在8只动物中，拔管后用改良的拉什金德伞形封堵器封堵房间隔穿孔。4周时纤维内皮组织覆盖了封堵器。在另外7只动物中，未封堵房间隔缺损。房间隔缺损在2周时缩小至针尖大小，4周时完全闭合。在10只绵羊中，经颈部通过纵隔穿刺左心房。左心室辅助血流量平均为71.6±14 mL·kg-1·min-1。左心室辅助1小时期间的平均失血量为47 mL。在8只动物中，封堵心房穿孔的平均失血量为253±194 mL。在2只动物中，故意未封堵穿孔，平均失血量为700 mL。所有动物均存活。改良的丹尼斯经心房法被推荐为一种安全、快速、经济有效的实施左心室辅助而无需开胸手术的方法。纵隔穿刺法在技术上对人类可行，但更困难但也是可行的。左心室辅助已被证明是使衰竭但仍有射血功能的左心室得到休息的最有效方法。不开胸实施左心室辅助可能会扩大左心室辅助在临时支持患有严重缺血性心脏病表现患者中的应用。
