Inoue Y, Yozu R, Mitsumaru A, Kawada S
Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
ASAIO J. 1994 Jul-Sep;40(3):M811-5. doi: 10.1097/00002480-199407000-00111.
Percutaneous balloon valvuloplasty is generally accepted, but post procedural complications limit its efficacy and reduce long-term success. To eliminate these risks, the authors explored the feasibility of cardioscopy guided percutaneous laser valvuloplasty in an experimental setting. The combined working model consisted of a separate balloon tipped thin fiber optic endoscope, laser balloon catheter, and a Nd-YAG laser transmitter. A porcine pulmonary valve was used as our in vivo target of laser ablation in a beating heart. Under general anesthesia, the endoscopic catheter is delivered into the pulmonary valve area through either the internal jugular or femoral vein under fluoroscopy. Positioning the pulmonary apparatus coaxial to the endoscopic visual field by manipulation of the catheter allowed for targeting and ablation of the commissure of the pulmonary valve under endoscopic view through the balloon filled with saline solution. The ablation energy was 15-30 W, 0.5-1.0 sec, and 2,000-3,000 J total. The animal was then killed and histopathologic study of the ablated area was done. The commissure of the pulmonary valve was smoothly ablated in 4 cases, and the entire ablation procedure was successfully witnessed through endoscopy. The authors encountered some difficulty in laser targeting, limitations to the endoscopic field of vision, and difficulty in holding the position of the apparatus in the beating heart. These are the barriers to overcome for future clinical application of this procedure. However, these results indicate the clear possibility of future use of cardioscopy guided percutaneous laser valvuloplasty in a clinical setting.
经皮球囊瓣膜成形术已被广泛接受，但术后并发症限制了其疗效并降低了长期成功率。为消除这些风险，作者在实验环境中探索了心脏镜引导下经皮激光瓣膜成形术的可行性。联合工作模型由一个单独的球囊尖端细光纤内窥镜、激光球囊导管和一个钕钇铝石榴石激光发射器组成。在跳动的心脏中，使用猪肺动脉瓣作为激光消融的体内靶点。在全身麻醉下，通过颈内静脉或股静脉在荧光透视引导下将内窥镜导管送入肺动脉瓣区域。通过操作导管使肺动脉装置与内窥镜视野同轴定位，从而在内窥镜视野下通过充满盐水溶液的球囊对肺动脉瓣的瓣叶交界进行靶向消融。消融能量为15 - 30瓦、0.5 - 1.0秒，总能量为2000 - 3000焦耳。然后处死动物并对消融区域进行组织病理学研究。4例中肺动脉瓣瓣叶交界被顺利消融，并且通过内窥镜成功见证了整个消融过程。作者在激光靶向、内窥镜视野受限以及在跳动的心脏中保持装置位置方面遇到了一些困难。这些是该手术未来临床应用需要克服的障碍。然而，这些结果表明心脏镜引导下经皮激光瓣膜成形术在临床环境中未来使用的明显可能性。
