尚小珂,张长东,陈澍,陈松,王雪丽,王斌,朱达,宋光远,廖曼,董念国

• 1:华中科技大学同济医学院附属协和医院心脏大血管外科
• 2:华中科技大学同济医学院附属协和医院心脏力学实验室
• 3:四川大学华西医院心脏外科
• 4:国家心血管病中心北京协和医学院中国医学科学院阜外医院结构性心脏病中心

摘要(Abstract)：

目的观察D-Shant心房分流器的动物预实验效果是否能达到预期。方法对4只实验用犬实施D-Shant心房分流器置入术,置入前后测量血流动力学及超声心动图检查相关心脏指标,并于饲养3个月后实施病理解剖学和组织学检查。结果 4只实验犬全部成功置入D-Shant心房分流器,即刻置入成功率100%,未见并发症发生。4只实验犬均存活至实验终点。心导管检查手术前后血流动力学显示,左心房压力由(16.75±3.20)mmHg(1 mmHg=0.133 kPa)降低至(9.25±2.63)mmHg(P=0.125),肺循环/体循环分流量由(0.97±0.02)上升至(1.30±0.14)(P=0.125);超声心动图检查手术前后左心房直径由术前(24.22±1.51)mm缩小至(18.68±0.87)mm(P=0.125),左心室直径由术前(36.52±2.27)mm缩小至(30.20±2.11)mm(P=0.125),左心室射血分数由术前(57.00±1.83)%升高至(61.25±2.50)%(P=0.125),二尖瓣反流程度由(3.25±0.50)级降低至(0.67±0.58)级(P=0.125),但因样本量小均未达到统计学差异。3个月后超声心动图观察所有实验犬房间隔分流仍然存在,均为单纯左向右分流。病理解剖学和组织学检查未见异常。结论动物实验初步验证了D-Shant心房分流器的置入具备可行性和较高的安全性,在改善心力衰竭血流动力学方面具备良好前景,是一个有希望的技术。

关键词(KeyWords)： 心力衰竭;房间隔;分流器;左心房压力;实验犬

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81570325);; 湖北省卫健委研究基金项目(WJ2019M173)

作者(Author): 尚小珂,张长东,陈澍,陈松,王雪丽,王斌,朱达,宋光远,廖曼,董念国

参考文献(References)：

• [1]国家卫生计生委员合理用药专家委员会，中国药师协会.心力衰竭合理用药指南(第2版).中国医学前沿杂志(电子版)，2019,11(7):1-78.
• [2]Del Trigo M,Rodés-Cabau J.Transcatheter structural heart interventions for the treatment of chronic heart failure.Cir Cardiovasc Interv,2015,8(7):e001943.
• [3]尚小珂，卢蓉，董念国，等.复杂先天性心脏病心脏移植杂交手术1例.中国介入心脏病学杂志，2017,25(4):227-228.
• [4]王春生，陈昊，洪涛，等.原位心脏移植治疗终末期心脏病141例.中华器官移植杂志，2006,27(3):152-155.
• [5]Guimaraes L,Lindenfeld J,Sandoval J,et al.Interatrial shunting for heart failure current evidence and future perspectives.Euro Intervention,2019,15(2):164-171.
• [6]Manuri L,Calaciura RE,De Zorzi A,et al.Atrial fl ow regulator for failing Fontan circulation:an initial European experience.Interact Cardiovasc Thorac Surg,2018,27(5):761-764.
• [7]陈伟伟，高润霖，刘力生，等.《中国心血管病报告2017》概要.中国循环杂志，2018,33(1):1-8.
• [8]Sorajja P,Samara MA,Eckman PM.Atrial shunting for heart failure where do we need to go?JACC Cardiovasc Interv,2018,11(22):2311-2313.
• [9]Reddy YNV,Borlaug BA,O'Connor CM,et al.Novel approaches to the management of chronic systolic heart failure:future directions and unanswered questions.Eur Heart J,2020,41(18):1764-1774.
• [10]尚小珂，陈澍，董念国，等.治疗心力衰竭新器械-心房分流器研究的进展.中国介入心脏病学杂志，2020,28(5):274-276.
• [11]廖曼，尚小珂，张长东，等.心房分流术治疗心力衰竭的研究进展.临床心血管病杂志，2020,36(3):222-227.
• [12]刘燕青，周欣蓓，蔡尚郎.心房分流术治疗慢性心力衰竭的研究进展.中国介入心脏病学杂志，2019,27(9):526-528.
• [13]Baumgartner H,Bonhoeffer P,De Groot NMS,et al.ESCGuidelines for the management of grown-up congenital heart disease(new version 2010).Eur Heart J,2010,31(23):2915-2957.
• [14]Wiedemann HR.Earliest description by Johann Friedrich Meckel,Senior(1750)of what is known today as Lutembacher syndrome(1916).Am J Med Genet,1994,53(1):59-64.
• [15]Feldman T,Komtebedde J,Burkhoff D,et al.Transcatheter interatrial shunt device for the treatment of heart failure:rationale and design of the randomized trial to REDUCE Elevated Left Atrial Pressure in Heart Failure(REDUCE LAP-HF I).Circ Heart Fail,2016,9(7):e003025.
• [16]Kaye DM,Hasenfu?G,Neuzil P,et al.One-year outcomes after transcatheter insertion of an interatrial shunt device for the management of heart failure with preserved ejection fraction.Circ Heart Fail,2016,9(12):e003662.
• [17]Feldman T,Mauri L,Kahwash R,et al.Transcatheter interatrial shunt device for the treatment of heart failure with preserved ejection f raction(REDUCE LAP-HF I[Reduce Elevated Lef t Atrial Pressure in Patients With Heart Failure])a phase 2,randomized,sham-controlled trial.Circulation,2018,137(4):364-375.
• [18]Del Trigo M,Rodés-Cabau J.Transcatheter structural heart interventions f or the treatment of chronic heart f ailure.Circ Cardiovasc Interv,2015,8(7):e001943.
• [19]Amat-Santos IJ,Del Trigo M,Bergeron S,et al.Left atrial decompression using unidirectional left-to-right interatrial shunt:initial experience in treating symptomatic heart failure with preserved ejection fraction with the W-Wave device.JACC Cardiovasc Interv,2015,8(6):870-872.
• [20]Amat-Santos IJ,Bergeron S,Bernier M,et al.Left atrial decompression through unidirectional left-to-right interatrial shunt for the treatment of left heart failure:fi rst-in-man experience with the V-Wave device.Euro Intervention,2015,10(9):1127-1131.
• [21]Rodés-Cabau J,Bernier M,Amat-Santos IJ,et al.Interatrial shunting for heart failure:early and late results from the firstin-human experience with the V-wave system.JACC Cardiovasc Interv,2018,11(22):2300-2310.
• [22]Maeder MT,Thompson BR,Brunner-La Rocca HP,et al.Hemodynamic basis of exercise limitation in patients with heart failure and normal ejection fraction.J Am Coll Cardiol,2010,56(11):855-863.
• [23]Dorfs S,Zeh W,Hochholzer W,et al.Pulmonary capillary wedge pressure during exercise and long-term mortality in patients with suspected heart failure and preserved ejection fraction.Eur Heart J,2014,35(44):3103-3112.