Department of Integrative Biology and Physiology, University of Minnesota Medical School, Minneapolis, Minnesota 55455-0250, USA.
Neuromodulation. 2011 Jul-Aug;14(4):337-41; discussion 341-2. doi: 10.1111/j.1525-1403.2011.00369.x. Epub 2011 Jul 7.
The objective of this study was to assess the potential of the pericardiophrenic veins (PPVs) as conduits for transvenous stimulation of the phrenic nerves. Modulating respiration with transvenous phrenic nerve stimulation via the PPVs might reduce or eliminate the adverse effects of central sleep apnea in heart failure.
Forty-eight fixed cadavers were dissected to study the anatomic characteristics of the PPVs and related neurovascular structures.
The right PPV, found in only 1 of 35 cadavers, was <0.5 mm diameter. The left PPV, located in all 48 cadavers, drained into the left brachiocephalic vein (BCV) directly or into the BCV via the superior intercostal vein (SICV). Mean ± SD SICV trunk diameter was 4 ± 2 mm. Mean ± SD left PPV diameter was 2 ± 1 mm. The length between the point of separation of the left PPV from the phrenic nerve to its junction with the BCV or SICV trunk ranged from 6 to 40 mm. The angle of approach, defined as the angle formed by the intersection of the longitudinal axis of the BCV and the longitudinal axis of the PPV or SICV trunk, and which represents the angle that would need to be navigated when inserting a stimulation lead into the PPV using a peripheral cannulation approach, was 99 ± 28 degrees. Valves were identified in 54% of left PPVs.
Because of its extremely small size, the right PPV appears unsuitable for transvenous phrenic nerve stimulation. In contrast, the left PPV may be accessible via the left BCV using standard transvenous catheterization techniques; however, the small caliber of the left PPV and the frequent presence of valves within it might pose challenges in navigating the vessel to achieve transvenous phrenic nerve stimulation.
本研究旨在评估心膈静脉（PPV）作为经静脉膈神经刺激的导管的潜力。通过 PPV 经静脉膈神经刺激调节呼吸可能会降低或消除心力衰竭患者中枢性睡眠呼吸暂停的不良反应。
对 48 具固定尸体进行解剖，以研究 PPV 及相关神经血管结构的解剖特征。
仅在 35 具尸体中的 1 具中发现右侧 PPV，其直径<0.5mm。左侧 PPV 位于所有 48 具尸体中，直接流入左侧头臂静脉（BCV）或通过肋间上静脉（SICV）流入 BCV。SICV 干的平均±SD 直径为 4±2mm。左侧 PPV 的平均±SD 直径为 2±1mm。从左侧 PPV 与膈神经分离点到与 BCV 或 SICV 干的汇合点之间的长度为 6-40mm。接近角定义为 BCV 的纵轴与 PPV 或 SICV 干的纵轴相交形成的角度，代表使用外周插管方法将刺激导线插入 PPV 时需要导航的角度，为 99±28°。在 54%的左侧 PPV 中发现了瓣膜。
由于其非常小的尺寸，右侧 PPV 似乎不适合经静脉膈神经刺激。相比之下，左侧 PPV 可能可以通过标准的经静脉导管技术通过左侧 BCV 进入；然而，左侧 PPV 的小口径和其内频繁存在的瓣膜可能会在导航血管以实现经静脉膈神经刺激时带来挑战。
