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Title:: Experimental study of incomplete endothelialization after atrial septal defect closure

作者:: 万陈; 成革胜; 张婷婷; 和旭梅; 张玉顺; (西安交通大学医学院第一附属医院心内二科，陕西西安 710061)

Author(s):: WAN Chen; CHENG Gesheng; ZHANG Tingting; HE Xumei; ZHANG Yushun; (Department of Cardiology, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China)

关键词:: 房间隔缺损; 封堵术; 内皮化不全; 犬

Keywords:: atrial septal defect; occluder; incomplete endothelialization; canines

分类号:: R541.1

DOI:: -

文献标识码:: A

摘要:: 目的:探讨封堵器大小与内皮化不全的相关性。方法:选择成年健康杂种犬18只，以自制房间隔打孔器建立统一大小（直径6 mm）的房间隔缺损(ASD)模型。将其随机分为A、B和C 3组，每组6只(n=6)，分别植入8 mm、12 mm和16 mm大小的封堵器，于术后3月及6月观察封堵器的形态和内皮化状况。结果:18只犬均成功建立ASD模型，超声测量缺损的大小为(6.0±0.2) mm。A组的封堵器伞盘形态扁平，厚度为(10.0±0.3) mm，B组的封堵器伞盘呈“贝壳状”，厚度为(15.4±1.7) mm，明显大于A组（P<0.05）。C组的封堵器伞盘呈“哑铃状”，厚度为(24.3±2.5) mm，显著大于前2组（P<0.05）。A组封堵器术后3个月内膜就基本完全覆盖；B组封堵器术后3月内膜覆盖不完整，伞盘表面内膜呈“岛状”覆盖，术后6个月膜覆盖进一步增加；C组封堵器伞盘术后3月绝大部分金属网裸露，术后6个月虽有增加，但仍大部分无内膜覆盖。结论:过大的封堵器可导致ASD封堵治疗后内皮化不全。

Abstract:: AIM:To explore the relationshiop between the size of the occluder and the incomplete endothelialization after atrial septal defect (ASD) closure. METHODS: Equalsized atrial septal defect models were established by homemade atrial septal perforators in 18 adult and healthy canines and then the canines were divided randomly into 3 groups, with 6 canines in each group. 8 mm occluders, with diameter 2 mm larger than the ASD, were implanted in group A, 12mm occluders, with diameter 6mm larger than the ASD, were implanted in group B, and 16mm occluders, with diameter 10 mm larger than the ASD, were implanted in group C. After 3 months and 6 months, morphological changes of the occluders and the endothelialization were observed. RESULTS: ASD models were successfully established in all 18 canines and the average ASD diameter was (60±02) mm measured by TTE. The morphological of the occluders were flat in group A and the average thickness was (100±03) mm. Which were conchoidal in group B,and the average thickness was (154±17) mm, significantly thicker than that in group A (P<005). The morphological of the occluders were dumbbellshaped in group C and the average thickness was (243±25) mm, significantly thicker than those in group B and group A (P<005; P<001). Three months after operation, the intima in group A was almost completely covered. Incomplete intimal coverage was observed in group B and the intima was an “islandlike” three months after operation, and the coverage area increased 6 months after operation. In group C, most of the occluders were exposed 3 months as well as 6 months after operation. CONCLUSION: Oversized occluders in transcatheter therapy of atrial septal defects may result in incomplete endothelialization.

参考文献/References

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房间隔缺损封堵术后内皮化不全的实验研究

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

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