Schuger C D, Steinman R T, Lehmann M H, Schuger L, Boldea D, McMath L, Spears J R
Department of Medicine, Wayne State University/Harper Hospital, Detroit, MI 48201.
Lasers Surg Med. 1990;10(2):140-8. doi: 10.1002/lsm.1900100206.
Transcatheter direct current electrical shocks for ablation of left-sided accessory pathways in Wolff-Parkinson-White patients have led to serious complications. We report the feasibility of percutaneous transcatheter laser balloon ablation of left-sided accessory pathways from the coronary sinus using a 1,064-nm, continuous wave Nd:YAG laser triple lumen catheter with an optical fiber terminating in a cylindrical diffusing tip within a 2-cm-long, 3-mm-diameter balloon transparent to Nd:YAG laser radiation. In eight mongrel dogs (18 to 31 kg), the laser balloon catheter was positioned via an 8 French guide catheter in the distal and proximal coronary sinus. During balloon inflation, two to three consecutive laser doses of 30 W x 20 sec were applied to each site (cumulative energy, 1,200 to 1,800 J). Coronary angiography, left ventriculography, and coronary sinus injection were performed before and after laser exposure. After percutaneous transcatheter laser balloon ablation, there was no evidence of mitral regurgitation, left circumflex artery, coronary sinus obstruction, or perforation. Coagulation necrosis and/or polymorphonuclear infiltrates involving the atrioventricular groove and left atrial wall over a mean length of 17 mm were present in all eight dogs sacrificed 6 +/- 1 hr postablation. In conclusion, percutaneous transcatheter laser balloon ablation from the coronary sinus is free of immediate major complications and may be feasible for potential interruption of left-sided accessory pathways.
经导管直流电电击用于消融预激综合征患者左侧旁路已导致严重并发症。我们报告了使用1064纳米连续波钕:钇铝石榴石激光三腔导管经皮经导管激光球囊消融冠状动脉窦左侧旁路的可行性，该导管的光纤末端位于一个2厘米长、3毫米直径的对钕:钇铝石榴石激光辐射透明的球囊内的圆柱形扩散尖端。在8只杂种犬（体重18至31千克）中，通过8法国引导导管将激光球囊导管置于冠状动脉窦远端和近端。在球囊充盈期间，对每个部位施加两到三个连续的30瓦×20秒激光剂量（累积能量1200至1800焦耳）。在激光照射前后进行冠状动脉造影、左心室造影和冠状动脉窦注射。经皮经导管激光球囊消融后，没有二尖瓣反流、左旋支动脉、冠状动脉窦梗阻或穿孔的证据。在消融后6±1小时处死的所有8只犬中，均出现了累及房室沟和左心房壁的凝固性坏死和/或多形核浸润，平均长度为17毫米。总之，经冠状动脉窦经皮经导管激光球囊消融无即刻重大并发症，对于潜在阻断左侧旁路可能是可行的。
