引發之心包黏連對急性心肌梗塞後左心室重塑之預防作用-動物實驗模式
Other Title
Prevention of left ventricular remodeling after acute myocardial
infarction by induction of pericardial adhesion - A porcine model
infarction by induction of pericardial adhesion - A porcine model
Date Issued
2004
Date
2004
Author(s)
廖朝崧
DOI
922314B002312
Abstract
Acute myocardial infarction (AMI) would proceed to left ventricular
remodeling, involving both the infarcted and the noninfarcted segments of left ventricle
(LV). During the acute phase of AMI, the noncontractile wall is most vulnerable to early
infarct expansion, prior to scar formation. Ventricular dilatation and subsequent
remodeling is more prone to occur in patients with large transmural infarctions. Left
ventricular remodeling results in a high risk of clinical complications such as aneurysm
formation, acute cardiac rupture, recurrent myocardial ischemic events, arrhythmias, and
congestive heart failure, with consequent premature mortality in the patients with
myocardial infarction. We proposal a hypothesis that soon after AMI, ventricular
containment by induction of pericardial adhesion might prevent the process of ventricular
remodeling through limiting the expansion and extension of infarct area. To test our
hypothesis we performed this study.
A total of 36 pigs, 7 farm hogs and 29 mini pigs, were put into this experiment. The
weight of the pigs was between 11 and 26 kgs. Among the 7 farm hogs, 6 (85.7%) died
during the initial experiment when induction of AMI was attempted. For the mini pigs, 7
(24.1%) from 29 pigs died during the procedure. RCA was the coronary artery occluded
in 4 pigs, 3 (75%) of them died during the procedure. LAD and LCX were the vessels
intervened in 16 and 13 pigs, respectively, with mortality during the operation in 3
(18.8%) and 7 (53.8%) pigs, respectively.
On 3 pigs, chemical injection into pericardial sac was not performed. Fibrin glue
injection into pericardial sac was performed on 5 pigs. One pig received injection with
both fibrin glue and mitomycin C 4 mg. There were 5 pigs injected with 4 mg of
mitomycin C and 8 pigs injected with 6 mg of that drug. There were 2 pigs with marked
pericardial adhesion. Other pigs showed no pericardial adhesion. Pathological
examination showed marked increase in heart weight in all experimental pigs in which
AMI was induced. It seemed that the increase in heart weight was not so remarkable in
the 2 pigs which showed pericardial adhesion.
It is concluded that in our experiment, due to the learning curve, we have high mortality rate in the process of AMI induction. LAD occlusion would result in lowest
mortality rate as comparing to RCA or LCX occlusion. Low success rate in the induction
of pericardial adhesion indicates the need for refining the method of induction of
pericardial adhesion.
Subjects
acute myocardial infarction
ventricular remodeling
pericardial adhesion
ventricular containment
SDGs
Publisher
臺北市：國立臺灣大學醫學院內科
Type
report
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