Rogers Toby, Ratnayaka Kanishka, Schenke William H, Faranesh Anthony Z, Mazal Jonathan R, O'Neill William W, Greenbaum Adam B, Lederman Robert J
Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
Department of Cardiology, Children's National Medical Center, Washington DC.
Catheter Cardiovasc Interv. 2015 Aug;86(2):E111-8. doi: 10.1002/ccd.25698. Epub 2014 Oct 28.
We test the safety of transatrial pericardial access using small catheters, infusion of carbon dioxide (CO2 ) or iodinated contrast to facilitate sub-xiphoid access, and catheter withdrawal under full anticoagulation.
Sub-xiphoid pericardial access is required for electrophysiological and structural heart interventions. If present, an effusion protects the heart from needle injury by separating the myocardium from the pericardium. However, if the pericardium is 'dry' then there is a significant risk of right ventricle or coronary artery laceration caused by the heart beating against the needle tip. Intentional right atrial exit is an alternative pericardial access route, through which contrast media could be infused to separate pericardial layers.
Transatrial pericardial access was obtained in a total of 30 Yorkshire swine using 4Fr or 2.8Fr catheters. In 16 animals, transatrial catheters were withdrawn under anticoagulation and MRI was performed to monitor for pericardial hemorrhage. In 14 animals, iodinated contrast or CO2 was infused before sub-xiphoid access was obtained.
Small effusions (mean 18.5 ml) were observed after 4Fr (1.3 mm outer-diameter) but not after 2.8Fr (0.9 mm outer-diameter) transatrial catheter withdrawal despite full anticoagulation (mean activated clotting time 383 sec), with no hemodynamic compromise. Pericardial CO2 resorbed spontaneously within 15 min.
Intentional transatrial exit into the pericardium using small catheters is safe and permits infusion of CO2 or iodinated contrast to separate pericardial layers and facilitate sub-xiphoid access. This reduces the risk of right ventricular or coronary artery laceration. 2.8Fr transatrial catheter withdrawal does not cause any pericardial hemorrhage, even under full anticoagulation.
我们测试使用小导管经心房心包穿刺的安全性、注入二氧化碳（CO₂）或碘化造影剂以促进剑突下穿刺以及在充分抗凝状态下拔出导管的安全性。
电生理和心脏结构干预需要进行剑突下心包穿刺。如果存在心包积液，可通过将心肌与心包分离来保护心脏免受针刺损伤。然而，如果心包“干燥”，则心脏撞击针尖会导致右心室或冠状动脉撕裂的重大风险。有意经右心房进入心包是一种替代的心包穿刺途径，通过该途径可注入造影剂以分离心包层。
总共对30只约克郡猪使用4Fr或2.8Fr导管进行经心房心包穿刺。在16只动物中，在抗凝状态下拔出经心房导管，并进行磁共振成像以监测心包出血情况。在14只动物中，在获得剑突下穿刺前注入碘化造影剂或CO₂。
尽管充分抗凝（平均活化凝血时间383秒），但在拔出4Fr（外径1.3mm）经心房导管后观察到少量心包积液（平均18.5ml），而拔出2.8Fr（外径0.9mm）经心房导管后未观察到心包积液，且无血流动力学损害。心包内的CO₂在15分钟内自发吸收。
使用小导管有意经心房进入心包是安全的，并且允许注入CO₂或碘化造影剂以分离心包层并促进剑突下穿刺。这降低了右心室或冠状动脉撕裂的风险。即使在充分抗凝状态下，拔出2.8Fr经心房导管也不会引起任何心包出血。
