Chachques Juan C, Azarine Arshid, Mousseaux Elie, El Serafi Mohamed, Cortes-Morichetti Miguel, Carpentier Alain F
Department of Cardiovascular Surgery, Pompidou and Bicetre Hospitals, Paris, France.
J Interv Cardiol. 2007 Jun;20(3):188-96. doi: 10.1111/j.1540-8183.2007.00255.x.
We compared two procedures for local myocardial treatment: transepicardial versus transendocardial catheter injection. Transepicardial injections were performed under direct surgical visualization whereas transendocardial injections were performed using electrophysiological guidance.
A left ventricle (LV) myocardial infarction (MI) was surgically created in 14 sheep. At 3 months, gadolinium was injected IV followed by the injection of super paramagnetic iron oxide (SPIO) into MI. Animals were divided in two groups: transepicardial injection (Group I) versus transendocardial (Group II) using "Cell-Fix" catheter injection. This catheter was developed to identify by electrophysiology the infarcted area and to stabilize injections suctioning the device to the endocardium. Postgadolinium delayed-enhancement magnetic resonance imaging (MRI) was performed to stain the infarct size. SPIO injections were used to assess the magnitude of the treated area. The ratio between SPIO black stained treatment areas and white gadolinium stained infarcted areas was calculated using MRI.
The electrophysiological recordings by the catheter for the MI versus normal LV wall were: R wave amplitude 4.16 versus 12.08 mV (P = 0.003), slew rate (slope of the signal) 0.36 V/s versus 1.04 V/s (P = 0.008). The ratio of the SPIO diffusion into the MI was 41.2 +/- 8.1% for surgical and 63.7 +/- 8.2% for percutaneous endocardial injections (P = 0.0132).
MRI allows evaluation of the extent of local myocardial treatments. The differences shown between epicardial and endocardial injections concerning the distribution of SPIO can be justified by the methodology of injection and by a more precise MI detection by electrophysiology. In conclusion, electrophysiological recordings to guide injections is superior to direct surgical visualization in terms of injecting into infarcted tissue.
我们比较了两种局部心肌治疗方法：经心外膜注射与经心内膜导管注射。经心外膜注射在手术直视下进行，而经心内膜注射则在电生理引导下进行。
对14只绵羊进行手术造成左心室（LV）心肌梗死（MI）。3个月时，静脉注射钆，随后将超顺磁性氧化铁（SPIO）注入心肌梗死部位。动物被分为两组：经心外膜注射组（I组）与经心内膜注射组（II组），采用“细胞固定”导管注射。该导管旨在通过电生理识别梗死区域，并通过将装置吸至心内膜来稳定注射。注射钆后进行延迟增强磁共振成像（MRI）以显示梗死面积。使用SPIO注射评估治疗区域的大小。通过MRI计算SPIO黑色染色的治疗区域与钆白色染色的梗死区域之间的比例。
导管对心肌梗死与正常左心室壁的电生理记录结果为：R波振幅4.16 mV对12.08 mV（P = 0.003），上升速率（信号斜率）0.36 V/s对1.04 V/s（P = 0.008）。手术注射时SPIO在心肌梗死区域的扩散率为41.2±8.1%，经皮心内膜注射时为63.7±8.2%（P = 0.0132）。
MRI可用于评估局部心肌治疗的范围。心外膜注射与心内膜注射在SPIO分布上的差异可以通过注射方法以及电生理对心肌梗死更精确的检测来解释。总之，在向梗死组织注射方面，电生理记录引导注射优于直接手术直视。
