Method for treating ischemic cardiac disease in an experiment

FIELD: medicine, cardiology, surgery.

SUBSTANCE: one should perform myocardial revascularization with laser radiation. Moreover, one should intravenously inject Photosens solution at 1.4-2.0 mg/kg body weight to irradiate boundary areas of myocardial ischemia with laser radiation at wave length being 675 nm, output power 150 mW, fiber's diameter being 0.6 mm, for 3-5 sec at 1-3 light impact/myocardial sq. cm. The innovation enables to decrease side effects.

EFFECT: higher efficiency of therapy.

 

The present invention relates to medicine, particularly cardiology, and may find application in the surgical treatment of chronic ischemic heart disease.

A known method of surgical treatment of chronic coronary heart disease (CHD), in particular transmyocardial laser revascularization (TMLR) different laser systems. When conducting TMLR laser radiation to create transmural channels from the epicardium to the endocardium with a laser to direct the receipt of oxygenated blood from the left ventricle to the thickness of the myocardium. When conducting TMLR laser radiation perforined myocardium, forming a pass-through channels with a diameter of up to 1.0 mm, using three main types of lasers: CO2laser, an excimer (l), holmium (Ho:YAG) (Lookery, Air, Wiebel, Iusosouv. “Transmyocardial laser myocardial revascularization”, 2001, Publisher Bakulev them. A.N. Bakulev, RAMS, Moscow, Russia).

The disadvantage of this method is the risk of complications: perforation of the myocardium may boil the blood, it is not excluded embolism, through the holes in the myocardium is bleeding requiring additional procedures and time to stop it difficult to control the depth and amount of necrosis, which is the trigger for revascularization.

Ass is her invention is to improve the effectiveness of treatment of chronic ischemic heart disease transmyocardial laser revascularization and reducing side effects.

The problem is solved by the method lies in the intravenous solution Photosense based 1,4-2,0 mg/kg of body weight and exposure to ischemic areas of the myocardium laser radiation with a wavelength of 675 nm, output power of 150 mW, with a fiber diameter of 0.6 mm, within 3-5 seconds of calculation 1-3 light effect on 1 cm2attack.

The effectiveness of the proposed method was proven experimental data. The method was developed in the experiment with 32 observations on the hearts of outbred rats weighing 200-250 grams. Experimental model of ischemic heart disease was called as follows: under the skin injected 4-8 mg calypsol 100 g weight. After the onset of anesthesia (characteristics: lateral position, no reaction to painful irritation caused by pinching of the tail of the rat was fixed to the operating table, removed the original ECG. In the trachea was introduced through the laryngoscope endotracheal tube and turned her cut of the tip in the direction of the right lung to reduce the inflating of the contralateral left lung, which stretch covers part of the heart and prevents manipulate it included artificial inhalation. The operation is carried out with observance of the rules of asepsis.

Made eye scissors skin incision on average sternal line from the jugular notch to me is Abednego process by a 5.5-5 mm, found keel part of the sternum (“elevation”); this finger glided over the breastbone from the xiphoid process to the jugular notch to nataskivanie on a kind of step, the rear end of “rise”, the corresponding rear edge of the 2nd rib and guide for reference edges. Useprofile the skin to the left of the incision. Ripped muscles that cover the ribs (large and small chest on the left side of the sternum, from the 2nd rib, stepping back from the edge of the sternum at 8-10 mm, and up to 5-6 th ribs, some distance from the sternum to the left by 3-5 mm; length of cut of 2.5-3 mm. Aside the edges of the muscles to become visible ribs 2-6, intercostal spaces and direct muscle traction belt extending parallel to the edge of the sternum at a distance of 5-6 mm to the left of it. Cut intercostal muscles was performed with scissors, some distance of 2.5-3 mm from the edge of the sternum in 3 - 4th intercostal space. The wound hole expanded two bezzaschitni forceps, introduced the allow; before that for a short time weakened (up to a stop at 2-3 (C) breathing and swelling of the lungs, to avoid injury with the introduction of the allow and to normalize the topography of the heart. Bred branches of they so that was good prominent heart along the entire length. Opened the pericardium blunt way, applied the guidelines for the search of the left coronary artery, left atrial appendage and pulmonary cone. P is oizvodil partial immobilization of the heart. To do this, under the right edge of it (the side and rear of the right ventricle) were placed a small swab; there, you can add a little immobilizers plastic spatula-a hook on the outer edge of which wore thin rubber ring (diameter 3-5 mm), fixed injection needle to the operating table. A small swab was taken to the side of the left ear, the result revealed the left edge of the pulmonary cone along which is usually shines in the form of whitish-pink strand initial division of the coronary artery. Felt tweezers with point swab anterior wall of the pulmonary cone and its region: the wall is thin and, unlike the left ventricle, pliable. Found the junction of the left edge of the cone at its base, the so-called lower left corner (in this place the left coronary artery deviates somewhat and goes steeply down to the top). Here and produced high ligation of the artery, which usually causes the formation of a massive heart attack. To do this, at the level of the lower-left corner of pulmonary cone or 2-3 mm down from him brought a ligature using atraumatic needle held by the needle holder; the needle provedly from the edge of the cone (vcol) towards the left ear (Vical), not reaching its transition into the wall of the Atria of about 11.5 mm; this held the needle through the wall of the left ventricle, deepening it by about 1.1-1.6 mm; fed ligature was tied around the artery and muscle bundles and witnessed the emergence of microprismatic ischemia: expressed blanching in the first 20-40 with changing seats or totally cyanosis; weakening contractions of ischemia; some dilation. In the absence of these signs ligation was repeated. This kept the heart was left in its natural place in the chest. If you had to ligitamate coronary artery at mid or low apical level, where it is usually not transparent, then held an imaginary line connecting the left corner of the pulmonary cone with apex, extending parallel to the side edge of the left ventricle, and applied along the specified lines to the appropriate level of the ligature according to the method similar to that described above. Removed the allow. Put three tightening the hub seam on the edge of the cut intercostal muscles, the distance between stitches 2-3 mm. Similar double continuous suture on top of the previously made tightly connected edges of the pectoral muscles; sutured to the edges of the skin wound continuous suture, smeared with iodine solution. Disable hardware breath; using tampons cleared his throat and mouth from mucus. In the first 2-3 days to rats injected penicillin 25-50 thousand is D. in day. Recorded ECG.

Intravenously injected with a solution of sulfonated aluminum phthalocyanine (2% solution "photosense") at a concentration of 1.4-2.0 mg/kg of body weight of the rat. Then was fulfilled the access to the myocardium. Determined concentration of the photosensitizer in the area of laser irradiation optical-spectral method and, when the value of the concentration of photosensitizer 0.5-1.0 mg/kg, were irradiated area of the myocardium laser source with a wavelength of 675 nm, output power of 150 mW, with a fiber diameter of 0.6 mm, within 3-5 seconds of calculation 1-3 light effect on 1 cm of the myocardium.

In the experiment all rats of either sex weighing 200-250 g were divided into 5 groups. Group I (control I) intact, performed only skin incision. Group II (control II) should only be done by ligation of the coronary artery, creating a zone of ischemia. Group III: create a zone of ischemia, intravenous injected with a solution of Photosense and perform the irradiation of the border zone ischemia in 2 points, leaving the label zone of irradiation. Group IV: create a zone of ischemia and intravenously injected with a solution of Photosense, irradiation was not performed. Group V: I created a zone of ischemia and perform the irradiation of the border zone ischemia in 2 points, leaving the label zone of irradiation. The number of surviving animals (from 1 day to 2 months, when they were full) 24 rats (74%)19 (60%) from 14 days to 2 months. 90% of the animals is C number lived 14-60 days histological examination of the area of the scar detected neovasculature, moreover, the maximum number in group III. Mortality in group III, 6%, IV and V groups 12 and 10%, respectively.

As shown, the method has higher efficiency compared to transmyocardial laser revascularization in the absence of Photosense and no side effects, while not formed through holes in the myocardium.

The method of surgical treatment of ischemic heart disease in the experiment, including myocardial revascularization by laser radiation, characterized in that the intravenous solution Photosense based 1,4-2,0 mg/kg of body weight and is exposed to the border zone of myocardial ischemia by laser radiation with a wavelength of 675 nm, output power of 150 mW, the fiber diameter of 0.6 mm, 3-5 with based 1-3 light effect on 1 cm2attack.



 

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