Kimura Takehiro, Miyoshi Shunichiro, Okamoto Kazuma, Fukumoto Kotaro, Tanimoto Kojiro, Soejima Kyoko, Takatsuki Seiji, Fukuda Keiichi
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
J Cardiothorac Surg. 2012 Nov 9;7:117. doi: 10.1186/1749-8090-7-117.
The efficacy and safety of rigid pericardial endoscopy as the promising minimally invasive approach to the pericardial space was evaluated. Techniques for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were developed.
Two swine and 5 canines were studied to evaluate the safety and efficacy of rigid pericardial endoscopy. After a double pericardiocentesis, a transurethral rigid endoscope was inserted into the pericardial space. The technique to obtain a clear visual field was examined, and acute complications such as hemodynamic changes and the effects on intra-pericardial pressure were evaluated. Using custom-made needles, pacemaker leads, and forceps, the applications for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were also evaluated.
The use of air, the detention of a stiff guide wire in the pericardial space, and the stretching of the pericardium with the rigid endoscope were all useful to obtain a clear visual field. A side-lying position also aided observation of the posterior side of the heart. As a cell transplantation methodology, we developed an ultrasonography-guided needle, which allows for the safe visualization of transplantation without major complications. Pacemaker leads were safely and properly implanted, which provides a better outcome for cardiac resynchronizing therapy. Furthermore, the success of clear visualization of the pulmonary veins enabled us to perform epicardial ablation.
Rigid pericardial endoscopy holds promise as a safe method for minimally invasive cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation by allowing clear visualization of the pericardial space.
评估了硬式心包内镜作为一种有前景的进入心包腔的微创方法的有效性和安全性。开发了细胞移植、心外膜起搏器导线植入和心外膜消融技术。
对2头猪和5只犬进行研究，以评估硬式心包内镜的安全性和有效性。在进行两次心包穿刺后，将经尿道硬式内窥镜插入心包腔。检查获得清晰视野的技术，并评估急性并发症，如血流动力学变化以及对心包内压力的影响。使用定制的针、起搏器导线和镊子，还评估了细胞移植、心外膜起搏器导线植入和心外膜消融的应用。
使用空气、在心包腔内留置硬导丝以及用硬式内窥镜拉伸心包，均有助于获得清晰的视野。侧卧位也有助于观察心脏后侧。作为一种细胞移植方法，我们开发了一种超声引导针，可安全地进行移植可视化且无重大并发症。起搏器导线安全且正确地植入，为心脏再同步治疗提供了更好的结果。此外，清晰可视化肺静脉的成功使我们能够进行心外膜消融。
硬式心包内镜有望成为一种安全的方法，通过清晰可视化心包腔来进行微创细胞移植、心外膜起搏器导线植入和心外膜消融。
