背景:有资料表明,猪的心血管系统的生物学特性与人类有极大的相似性,其代谢、免疫系统、疾病的发生机制等方面与人类有99%的共源性。目的:拟通过介入封堵左前降支建立规范化的猪室壁瘤模型。设计、时间及地点:动物观察实验,于2005-12/2007-07在同济大学附属同济医院功能材料实验室及动物实验中心完成。材料:枫泾家猪13只,雌雄不拘,体质量30~40kg。方法:在充分腹腔、静脉麻醉诱导下,对13只家猪行经皮股动脉穿刺,置入7号动脉鞘管,在数字减影血管造影下经鞘管在导丝引导下通过球囊将“WYW”冠状动脉栓塞装置输送至前降支第一对角支开口处远端,扩张球囊,释放栓塞装置,再次行冠脉造影,确认栓塞装置对冠脉前降支已形成可靠的封堵。术中、术后严密心电血压监测并予血管活性药物维持生命体征平稳。主要观察指标:观测心电图、血清心肌酶谱、心肌核素显像、超声心动图、心血管照影及病理学变化。结果:1只动物在术前死于麻醉意外,6只在封堵过程中死于心室颤动,其余6只均存活。术后4周复查冠脉照影显示,远端血流已100%阻塞,左室照影示心尖部及左室前壁室壁运动消失。栓塞前心电监护显示心电图呈正常表现,阻断后即刻出现ST段持续性抬高,R波振幅降低,T波高耸,ST-T融合波出现,胸前导联明显。ST段约2周后降回基线,术后4周可见病理性Q波。术后12h血清肌钙蛋白测定较术前均有不同程度升高(P<0.01)。放射性核素心肌显像可见心尖和左室前壁呈放射性的核素灌注充盈缺损,室壁变薄,有室壁瘤形成。心脏超声显示,6只动物均出现室壁局部节段性收缩运动减弱,以左室前壁及心尖部尤显。苏木精-伊红染色后光镜下观察可见心尖梗死区心肌纤维消失、被胶原纤维所取代,其间有少量毛细血管;右室前壁梗死边缘区有残留心肌纤维核固缩、溶解,除胶原纤维填充外还有较多炎症细胞和毛细血管浸润。结论:应用“WYW”介入栓塞法建立的室壁瘤模型较接近临床病理生理演变过程,效果确切可靠。 Background: It is indicated that the biological characteristics of the pig’s cardiovascular system are very similar to those of humans. The metabolism, the immune system and the pathogenesis of the disease are 99% common with humans. OBJECTIVE: To establish a standardized model of porcine cirrhotic aneurysm by interventional occlusion of the left anterior descending artery. DESIGN, TIME AND SETTING: The animal experiment was performed at Functional Materials Laboratory and Animal Experiment Center, Tongji Hospital Affiliated to Tongji University from December 2005 to July 2007. Material: 13 Feng Jing domestic pigs, both male and female, body mass 30 ~ 40kg. Methods: Thirteen pigs underwent percutaneous femoral artery puncture under the guidance of adequate intraperitoneal and intravenous anesthesia. Arterial sheaths on the 7th were placed under the guidance of guidewire in the digital subtraction angiography. The “WYW” coronary artery embolization device was delivered to the distal end of the first diagonal branch of the anterior descending artery, the balloon was dilated, the embolization device was released and coronary angiography was performed again to confirm that the embolization device had formed a reliable Plugged. Intraoperative and postoperative close monitoring of blood pressure and vasoactive drugs to maintain vital signs stable. MAIN OUTCOME MEASURES: Electrocardiogram, serum myocardial enzymes, myocardial radionuclide imaging, echocardiography, cardiovascular imaging and pathological changes. Results: One animal died of anesthesia before surgery, 6 died of ventricular fibrillation during the occlusion, and the remaining 6 survived. 4 weeks after coronary angiography showed that the distal blood flow has been 100% occlusion, left atrocenter showed apical and left ventricular wall wall motion disappeared. Pre-embolic ECG showed normal ECG showed immediately after the block ST segment elevation, R wave amplitude decreased, T wave towering, ST-T fusion wave appeared, chest lead significantly. ST segment returned to baseline after about 2 weeks, 4 weeks after the pathological Q wave. Serum troponin measured at 12 hours after operation was significantly higher than that before operation (P <0.01). Radionuclide myocardial imaging showed apical and left anterior wall radioactive nuclide perfusion filling defect, wall thinning, aneurysm formation. Echocardiography showed that all 6 animals showed a local segmental contraction of the wall and weakened, particularly in the anterior wall of the left ventricle and apical part. After hematoxylin-eosin staining, the myocardial fibers disappeared in the apical infarction area and were replaced by collagen fibers with a few capillaries during the light microscopy. Residual cardiac fibril nucleus were contracted and dissolved in the marginal zone of right anterior ventricular wall, There are more collagen fibers filled with inflammatory cells and capillary infiltration. Conclusion: The model of ventricular aneurysm established by the interventional “WYW” embolization method is closer to the clinical pathophysiological evolution and the effect is reliable.