Uchida Y, Nakamura F, Oshima T, Fujimori Y, Hirose J
Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan.
Am Heart J. 1990 Sep;120(3):677-87. doi: 10.1016/0002-8703(90)90027-u.
Left ventricular luminal changes were examined by percutaneous fiberoptic angioscopy in 13 patients with dilated cardiomyopathy and in four patients with acute myocarditis. Angioscope-guided endomyocardial biopsy was also performed in six patients with dilated cardiomyopathy and in two with acute myocarditis. A balloon-tipped guiding catheter (9F) was introduced through the right femoral artery into the left ventricle, the balloon was inflated, and a 1.6 or 4.3F fiberscope was introduced through the catheter into the ventricle so as to locate the fiberscope tip at the tip of the catheter shaft. The balloon was then pushed against the desired portion of the ventricle and warmed saline was infused to observe the luminal changes. In contrast to the patients without organic heart disease whose left ventricular luminal surface was brown in color, the luminal surface was white or light yellow in four, light brown in one, bluish-white in one, with white and brown portions distributed in a mosaic pattern in four, and it was reddish brown in the remaining one patient with dilated cardiomyopathy. Mural thrombi were observed in two of the patients. The luminal surface was light brown in one, reddish brown in one, rose in one, and red in one patient with acute myocarditis. Thrombi and scattered bleeding were observed in two and one of these patients, respectively. The changes in luminal coloration in patients with dilated cardiomyopathy and acute myocarditis had no obvious relation to left ventricular volume and ejection fraction. Angioscope-guided biopsy revealed that the white and light yellow portions were due to endocardial fibrosis, that the endocardia of brown portions were not fibrotic, and that the myocardium in the red portions contained mononuclear cells, indicating inflammation. The results indicate that the angioscopic features of the left ventricular luminal surface were not uniform in patients with dilated cardiomyopathy or in those with acute myocarditis, and that angioscopy can be used as a guiding tool for endomyocardial biopsy.
通过经皮纤维光学血管镜检查了13例扩张型心肌病患者和4例急性心肌炎患者的左心室腔变化。还对6例扩张型心肌病患者和2例急性心肌炎患者进行了血管镜引导下的心内膜心肌活检。将带球囊的引导导管（9F）经右股动脉插入左心室，充盈球囊，然后将1.6F或4.3F的纤维镜经导管插入心室，使纤维镜尖端位于导管轴尖端处。然后将球囊推向心室的目标部位，并注入温热盐水以观察腔变化。与无器质性心脏病患者左心室腔表面呈棕色不同，13例扩张型心肌病患者中，4例腔表面呈白色或浅黄色，1例呈浅棕色，1例呈蓝白色，4例呈白色和棕色部分呈镶嵌状分布，其余1例呈红棕色。2例患者观察到壁血栓。4例急性心肌炎患者中，1例腔表面呈浅棕色，1例呈红棕色，1例呈玫瑰色，1例呈红色。这些患者中分别有2例和1例观察到血栓和散在出血。扩张型心肌病和急性心肌炎患者腔颜色变化与左心室容积和射血分数无明显关系。血管镜引导下活检显示，白色和浅黄色部分是由于心内膜纤维化，棕色部分的心内膜未纤维化，红色部分的心肌含有单核细胞，提示有炎症。结果表明，扩张型心肌病患者或急性心肌炎患者左心室腔表面的血管镜特征并不一致，血管镜可作为心内膜心肌活检的引导工具。
