Galal O, Weber H P, Enders S, al Watban F, ElSayet R M, Duran C
Department of Cardiovascular Diseases, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
Int J Cardiol. 1993 Nov;42(1):31-5. doi: 10.1016/0167-5273(93)90099-3.
The feasibility of percutaneous transluminal catheter-directed laser (Argon multiline 488/514 nm) atrial septostomy under echocardiographic guidance was studied in eight rabbits. In five animals the interatrial septum was exposed to laser energy for 30 s (n = 1) or for 10 s (n = 4) by using the continuous wave (cw) mode of irradiation. In the other three animals chopped mode of irradiation was applied for 10 s at 7 W. Echocardiography allowed visualization of both atrial cavities and the interatrial septum, the tip of the catheter including the optical fiber tip as well as the flow direction of contrast echoes during the laser firing. Blood clotting with thrombus formation was present following the cw mode of irradiation. The defects created in the interatrial septa of < or = 0.3 mm in diameter had irregular black borders and, histopathologically, were surrounded by a zone of coagulation necrosis of < or = 0.2 mm and vacuolization (vacuoles of < 0.1 mm in diameter). After 30 s of lasering a huge defect was conspicuous in the interatrial septum which extended up to the right and left atrial roof. The chopped mode of irradiation induced less blood clotting and narrow channels of < or = 0.08 mm through the interatrial septa with a small zone of coagulation necrosis of < or = 0.05 mm and without carbonization and vacuolization. This study demonstrates that laser atrial septostomy is technically feasible. However, prior to the extension of the method to humans, further investigation especially considering other laser power sources, possibly more suitable for this application such as Neodymium-YAG or Excimer lasers is warranted.
在八只兔子身上研究了在超声心动图引导下经皮腔内导管导向激光（氩多线488/514纳米）房间隔造口术的可行性。在五只动物中，通过使用连续波（cw）照射模式，将房间隔暴露于激光能量下30秒（n = 1）或10秒（n = 4）。在另外三只动物中，以7瓦的功率采用斩波照射模式照射10秒。超声心动图能够显示两个心房腔、房间隔、包括光纤尖端在内的导管尖端以及激光发射期间造影剂回声的流动方向。连续波照射模式后出现了伴有血栓形成的血液凝固。在房间隔中形成的直径≤0.3毫米的缺损具有不规则的黑色边界，并且在组织病理学上，被≤0.2毫米的凝固性坏死区和空泡化（直径<0.1毫米的空泡）所包围。激光照射30秒后，房间隔出现一个巨大的缺损，延伸至左右心房顶部。斩波照射模式引起的血液凝固较少，通过房间隔形成的通道狭窄，直径≤0.08毫米，伴有≤0.05毫米的小凝固性坏死区，且无碳化和空泡化。本研究表明激光房间隔造口术在技术上是可行的。然而，在将该方法推广应用于人类之前，有必要进行进一步研究，尤其是考虑其他可能更适合此应用的激光源，如钕钇铝石榴石激光或准分子激光。
