Rosa Benoit, Machaidze Zurab, Mencattelli Margherita, Manjila Sunil, Shin Borami, Price Karl, Borger Michael A, Thourani Vinod, Del Nido Pedro, Brown David W, Baird Christopher W, Mayer John E, Dupont Pierre E
Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Massachusetts.
New York Presbyterian-Columbia University Medical Center, New York, New York.
Ann Thorac Surg. 2017 Sep;104(3):1074-1079. doi: 10.1016/j.athoracsur.2017.03.028.
There remains a paucity of direct visualization techniques for beating-heart intracardiac procedures. To address this need, we evaluated a novel cardioscope in the context of aortic paravalvular leaks (PVLs) localization and closure.
A porcine aortic PVL model was created using a custom-made bioprosthetic valve, and PVL presence was verified by epicardial echocardiography. Transapical delivery of occlusion devices guided solely by cardioscopy was attempted 13 times in a total of three pigs. Device retrieval after release was attempted six times. Echocardiography, morphologic evaluation, and delivery time were used to assess results.
Cardioscopic imaging enabled localization of PVLs via visualization of regurgitant jet flow in a paravalvular channel at the base of the prosthetic aortic valve. Occluders were successfully placed in 11 of 13 attempts (84.6%), taking on average 3:03 ± 1:34 min. Devices were cardioscopically removed successfully in three of six attempts (50%), taking 3:41 ± 1:46 min. No damage to the ventricle or annulus was observed at necropsy.
Cardioscopy can facilitate intracardiac interventions by providing direct visualization of anatomic structures inside the blood-filled, beating-heart model.
对于心脏跳动时的心内手术，直接可视化技术仍然匮乏。为满足这一需求，我们在主动脉瓣周漏（PVL）定位和封堵的背景下评估了一种新型心脏内窥镜。
使用定制的生物瓣膜创建了猪主动脉瓣周漏模型，并通过心外膜超声心动图验证了瓣周漏的存在。在总共三头猪中，仅在心脏内窥镜引导下经心尖尝试输送封堵装置13次。释放后尝试回收装置6次。使用超声心动图、形态学评估和输送时间来评估结果。
心脏内窥镜成像能够通过可视化人工主动脉瓣基部瓣周通道内的反流束来定位瓣周漏。13次尝试中有11次（84.6%）成功放置封堵器，平均用时3:03±1:34分钟。6次尝试中有3次（50%）通过心脏内窥镜成功取出装置，用时3:41±1:46分钟。尸检时未观察到心室或瓣环受损。
心脏内窥镜检查可通过直接可视化充满血液的跳动心脏模型内的解剖结构来促进心内干预。
