Sun Fei, Sánchez Francisco M, Fernández-Portales Javier, Crisóstomo Verónica, Díaz-Güemes Idoia, Báez-Díaz Claudia, Usón Jesús, Maynar Manuel
Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.
J Invasive Cardiol. 2012 May;24(5):210-4.
A minimally invasive pericardial access and chronic catheterization may enhance the therapeutic effects of intrapericardial drug delivery. We aimed to evaluate the technical feasibility of percutaneous intrapericardial implantation of a drug port system for chronic local drug delivery.
Under fluoroscopic guidance, a percutaneous subxiphoid access to the pericardial space was obtained with fine needle and micropuncture set in 6 Göttingen minipigs. A 6.4 Fr silicone tube and its drug port were implanted into the pericardial space and a subcutaneous pocket. One animal was euthanized immediately after procedure for acute macroscopic study. The other 5 animals were followed monthly for 2 months and then euthanized for chronic macroscopic study. Technical success was obtained in all animals. The mean procedure duration was 55.3 ± 9.6 minutes and the mean radiation exposure time was 7.9 ± 1.9 minutes. Acute macroscopic study showed no pericardial laceration at the entry site and no gross injury to the nearby epicardium. Follow-ups demonstrated that the pericardial space was intact and silicone catheters kept patent in all cases. No migration of the catheter tip out of the pericardial space or leakage of contrast was observed. All the catheters were easily removed at the end of study. Infection of the subcutaneous tunnel as a major complication was found in 1 pig. Small scattered adhesions of the pericardial space were observed in 2 pigs at chronic macroscopic study.
Percutaneous intrapericardial catheterization for chronic local drug delivery is technically feasible and of potential for clinical trial.
微创心包穿刺通路及长期置管可能会增强心包内给药的治疗效果。我们旨在评估经皮心包内植入药物端口系统用于长期局部给药的技术可行性。
在透视引导下，使用细针和微穿刺套件经剑突下入路对6只哥廷根小型猪进行心包腔穿刺。将一根6.4 Fr硅胶管及其药物端口植入心包腔和皮下囊袋。1只动物在术后立即安乐死用于急性大体研究。另外5只动物每月随访2个月，然后安乐死用于慢性大体研究。所有动物均获得技术成功。平均手术时间为55.3±9.6分钟，平均辐射暴露时间为7.9±1.9分钟。急性大体研究显示，穿刺入口处无心包撕裂，附近的心外膜无明显损伤。随访表明，所有病例的心包腔均完整，硅胶导管保持通畅。未观察到导管尖端移出心包腔或造影剂渗漏。在研究结束时，所有导管均易于取出。1只猪出现了作为主要并发症的皮下隧道感染。在慢性大体研究中，2只猪观察到心包腔有小的散在粘连。
经皮心包内置管用于长期局部给药在技术上是可行的，具有开展临床试验的潜力。
