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使用直接瓣叶和腱索射频消融术进行黏液样二尖瓣修复的可行性。

Feasibility of myxomatous mitral valve repair using direct leaflet and chordal radiofrequency ablation.

作者信息

Williams Jeffrey L, Toyoda Yoshiya, Ota Takeyoshi, Gutkin Dmitry, Katz William, Zenati Marco, Schwartzman David

机构信息

Good Samaritan Health System, Lebanon Cardiology Associates, Lebanon, Pennsylvania 17042, USA.

出版信息

J Interv Cardiol. 2008 Dec;21(6):547-54. doi: 10.1111/j.1540-8183.2008.00398.x. Epub 2008 Oct 21.

DOI:10.1111/j.1540-8183.2008.00398.x
PMID:18973508
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2602795/
Abstract

OBJECTIVE

Minimally invasive repair of mitral valve prolapse (MVP) causing severe mitral regurgitation (MR) should reduce MR and have chronic durability. Our ex vivo, acute in vivo, and chronic in vivo studies suggest that direct application of radiofrequency ablation (RFA) to mitral leaflets and chordae can effect these repair goals to decrease MR.

METHODS

A total of seven canines were studied to assess the effects of RFA on mitral valve structure and function. RFA was applied ex vivo (n = 1), acutely in vivo using a right lateral thoracotomy and cardiopulmonary bypass (n = 3), and chronically in vivo using percutaneous access to the heart (n = 3). RFA was applied to the mitral valve and its associated chordae. Mitral valve structure and function (in vivo preparations) were then assessed.

RESULTS

Ex vivo application of RFA resulted in qualitative reduction in mitral leaflet surface area and chordal length. Acute in vivo application of RFA to canines found to have MVP causing severe MR demonstrated a 43.7-60.7% statistically significant (P = 0.039) reduction in postablation MR. Chronic, in vivo, percutaneous application of RFA was found to be feasible and the engendered alterations durable.

CONCLUSION

These data suggest that myxomatous mitral valve repair using radiofrequency energy delivered via catheter is feasible.

摘要

目的

对导致严重二尖瓣反流（MR）的二尖瓣脱垂（MVP）进行微创修复应能减少MR并具备长期耐久性。我们的体外、急性体内和慢性体内研究表明，直接对二尖瓣瓣叶和腱索施加射频消融（RFA）可实现这些修复目标以减少MR。

方法

共研究了7只犬，以评估RFA对二尖瓣结构和功能的影响。RFA应用于体外（n = 1），通过右侧胸廓切开术和体外循环在急性体内应用（n = 3），以及通过经皮进入心脏在慢性体内应用（n = 3）。RFA应用于二尖瓣及其相关腱索。然后评估二尖瓣结构和功能（体内制剂）。

结果

体外应用RFA导致二尖瓣瓣叶表面积和腱索长度定性减少。对患有导致严重MR的MVP的犬急性体内应用RFA显示，消融后MR有43.7 - 60.7%的统计学显著降低（P = 0.039）。发现慢性体内经皮应用RFA是可行的，且产生的改变具有耐久性。

结论

这些数据表明，通过导管输送射频能量进行黏液瘤样二尖瓣修复是可行的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4669/2602795/1f794602ec94/nihms80795f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4669/2602795/c3a09a42fc1e/nihms80795f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4669/2602795/aa0b5189adab/nihms80795f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4669/2602795/77b01cb1022d/nihms80795f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4669/2602795/5163f92889c7/nihms80795f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4669/2602795/1f794602ec94/nihms80795f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4669/2602795/c3a09a42fc1e/nihms80795f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4669/2602795/aa0b5189adab/nihms80795f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4669/2602795/77b01cb1022d/nihms80795f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4669/2602795/5163f92889c7/nihms80795f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4669/2602795/1f794602ec94/nihms80795f5.jpg

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