治疗缺血性/功能性二尖瓣反流的二尖瓣成形环是否会改变急性缺血性羊心的左心室尺寸？
Do annuloplasty rings designed to treat ischemic/functional mitral regurgitation alter left-ventricular dimensions in the acutely ischemic ovine heart?
机构信息
Department of Cardiovascular Surgery, Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif; Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
出版信息
J Thorac Cardiovasc Surg. 2019 Oct;158(4):1058-1068. doi: 10.1016/j.jtcvs.2018.12.077. Epub 2019 Jan 11.
OBJECTIVE
To quantify the effects of annuloplasty rings designed to treat ischemic/functional mitral regurgitation on left ventricular septal-lateral (S-L) and commissure-commissure (C-C) dimensions.
METHODS
Radiopaque markers were placed as opposing pairs on the S-L and C-C aspects of the mitral annulus and the basal, equatorial, and apical level of the left ventricle (LV) in 30 sheep. Ten true-sized Carpentier-Edwards Physio (PHY), Edwards IMR ETlogix (ETL), and GeoForm (GEO; all from Edwards Lifesciences, Irvine, Calif) annuloplasty rings were inserted in a releasable fashion. After 90 seconds of left circumflex artery occlusion with the ring implanted (RING), 4-dimensional marker coordinates were obtained using biplane videofluoroscopy. After ring release, another data set was acquired after another 90 seconds of left circumflex artery occlusion (NO RING). S-L and C-C diameters were computed as the distances between the respective marker pairs at end-diastole. Percent change in diameters was calculated between RING versus NO RING as 100 × (diameter in centimeters [RING] - diameter in centimeters [NO RING])/diameter in centimeters [NO RING]).
RESULTS
Compared with NO RING, all ring types (PHY, ETL, and GEO) reduced mitral annular S-L dimensions by -20.7 ± 5.6%, -26.8 ± 3.9%, and -34.5 ± 3.8%, respectively. GEO reduced the S-L dimensions of the LV at the basal level only by -2.3 ± 2.4%, whereas all other S-L dimensions of the LV remained unchanged with all 3 rings implanted. PHY, ETL, and GEO reduced mitral annular C-C dimensions by -17.5 ± 4.8%, -19.6 ± 2.5, and -8.3 ± 4.9%, respectively, but none of the rings altered the C-C dimensions of the LV.
CONCLUSIONS
Despite radical reduction of mitral annular size, disease-specific ischemic/functional mitral regurgitation annuloplasty rings do not induce relevant changes of left ventricular dimensions in the acutely ischemic ovine heart.
目的
定量分析旨在治疗缺血/功能性二尖瓣反流的瓣环成形术对二尖瓣环前后（S-L）和瓣环交叉（C-C）径线的影响。
方法
在 30 只绵羊的二尖瓣环 S-L 和 C-C 以及左心室（LV）基底、赤道和心尖水平上，将放射状标记物成对放置。以可释放方式植入 10 个真实尺寸的 Carpentier-Edwards Physio（PHY）、Edwards IMR ETlogix（ETL）和 GeoForm（GEO；均来自爱德华兹生命科学公司，加利福尼亚州欧文市）瓣环成形术环。植入环后，左回旋支闭塞 90 秒（RING），使用双平面荧光透视术获取 4 维标记物坐标。释放环后，再次闭塞左回旋支 90 秒（NO RING），获得另一组数据。舒张末期时，分别计算 S-L 和 C-C 直径为相应标记对之间的距离。与无环时相比，计算 RING 与 NO RING 之间的直径变化百分比，即 100×（厘米径[RING]–厘米径[NO RING]）/厘米径[NO RING]）。
结果
与无环时相比，所有环类型（PHY、ETL 和 GEO）分别使二尖瓣环 S-L 直径减小 20.7±5.6%、26.8±3.9%和 34.5±3.8%。GEO 仅使 LV 基底水平的 S-L 直径减小 2.3±2.4%，而所有 3 个环植入后，LV 的其他 S-L 直径均无变化。PHY、ETL 和 GEO 分别使二尖瓣环 C-C 直径减小 17.5±4.8%、19.6±2.5%和 8.3±4.9%，但所有环均未改变 LV 的 C-C 直径。
结论
尽管二尖瓣环明显缩小，但针对特定疾病的缺血/功能性二尖瓣反流瓣环成形术并未在急性缺血绵羊心脏中引起左心室尺寸的相关变化。
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