Bical O, Gallix P, Toussaint M, Landais P, Gaillard D, Karam J, Neveux J Y
Department of Experimental Surgery, Faculté de Médecine Necker, Enfants Malades, Paris, France.
J Thorac Cardiovasc Surg. 1990 Apr;99(4):685-90.
Experimental lamb models were used for intrauterine creation of pulmonary artery stenosis and later intrauterine repair or postnatal repair. Intrauterine creation of pulmonary artery stenosis was performed in 23 fetal lambs at 90 +/- 1 days of gestation. Eight lambs underwent intrauterine repair of pulmonary artery stenosis at 135 +/- 1 days of gestation and were studied 110 +/- 13 days after repair. Seven lambs underwent postnatal repair at 57 +/- 9 days after birth and were studied 162 +/- 32 days after repair. Eight fetal lambs with unrepaired pulmonary artery stenosis were studied 89 +/- 18 days after birth. All study lambs were compared with normal control lambs. The systolic right ventricular pressure was significantly higher after unrepaired stenosis (78.6 +/- 6.8 mm Hg) than in other lambs, but there was no statistically significant difference after intrauterine repair (23.3 +/- 2.9 mm Hg), postnatal repair (25.9 +/- 3.4 mm Hg), and normal lambs (21.6 +/- 1.1 mm Hg). The systolic pulmonary artery pressure was also not statistically different in these three groups. The weight measurements were age-adjusted for comparison of postnatal and intrauterine repair with normal lambs. The adjusted heart weights were similar in the three groups. The comparison of the adjusted heart weight/adjusted body weight ratio (10(-3) showed a significantly higher ratio in postnatal repair (7.4 +/- 0.1) than in intrauterine repair (6.1 +/- 0.1). The adjusted right ventricular weight/adjusted left ventricular weight ratio was significantly higher in the postnatal repair group (0.71 +/- 0.01) than in both the intrauterine repair group (0.59 +/- 0.01) and normal lambs (0.59 +/- 0.01). The transverse myocyte diameter was not statistically different in all groups of animals and there were no ultrastructural changes even when the pulmonary stenosis was unrepaired. We conclude that intrauterine repair was more satisfactory than postnatal repair in terms of age-adjusted heart weight results, but we did not find any advantages of intrauterine repair in terms of histologic and ultrastructural changes.
实验性羔羊模型用于在子宫内制造肺动脉狭窄，随后进行子宫内修复或出生后修复。在妊娠90±1天的23只胎羊中进行子宫内肺动脉狭窄制造。8只羔羊在妊娠135±1天接受了子宫内肺动脉狭窄修复，并在修复后110±13天进行研究。7只羔羊在出生后57±9天接受了出生后修复，并在修复后162±32天进行研究。8只患有未修复肺动脉狭窄的胎羊在出生后89±18天进行研究。所有研究羔羊均与正常对照羔羊进行比较。未修复狭窄后收缩期右心室压力（78.6±6.8 mmHg）显著高于其他羔羊，但子宫内修复后（23.3±2.9 mmHg）、出生后修复后（25.9±3.4 mmHg）与正常羔羊（21.6±1.1 mmHg）之间无统计学显著差异。这三组的收缩期肺动脉压力也无统计学差异。对体重测量值进行年龄校正，以便将出生后和子宫内修复与正常羔羊进行比较。三组的校正心脏重量相似。校正心脏重量/校正体重比（10⁻³）的比较显示，出生后修复组（7.4±0.1）显著高于子宫内修复组（6.1±0.1）。出生后修复组的校正右心室重量/校正左心室重量比（0.7±0.01）显著高于子宫内修复组（0.59±0.01）和正常羔羊（0.59±0.01）。所有动物组的横向心肌细胞直径无统计学差异，即使肺动脉狭窄未修复，也未发现超微结构变化。我们得出结论，就年龄校正后的心脏重量结果而言，子宫内修复比出生后修复更令人满意，但在组织学和超微结构变化方面，我们未发现子宫内修复有任何优势。
