title: Safety and efficacy of pericardial endoscopy by percutaneous subxyphoid approach in swine heart in vivo.
abstract: OBJECTIVE
  A nonsurgical approach from the epicardial surface is useful for various cardiac interventions, such as positioning of the left ventricular lead for cardiac resynchronization therapy and epicardial ablation. Stem cell delivery on the epicardial surface can be considered in the future if good quality of visualization can be obtained. However, because the pericardial space is limited, hemodynamic conditions may deteriorate with pericardial endoscopy. Therefore, the feasibility and efficacy of pericardial endoscopy were examined by using ready-made endoscopes.
  
  
  METHODS
  Anesthetized swines (26-61 kg; n = 6) were used for the experiment. Electrocardiogram, femoral artery blood pressure, and oxygen saturation by pulse oximetry were continuously monitored during the procedures. Guided by the fluoroscopy, sheaths were advanced to the pericardial space using the modified Seldinger technique from the subxyphoid space.
  
  
  RESULTS
  After insertion of an endoscope with a maximum diameter of 6.9 mm, hemodynamic parameters were stable during the procedure with atropine. Stable and acceptable endoscopic images were obtained. Minor operations can be performed with pericardial endoscopic-guided laparoscopic forceps with no complications.
  
  
  CONCLUSIONS
  The endoscopic pericardial procedure is effective and feasible. This procedure can increase the possibility and efficacy of nonsurgical treatment for cardiac diseases.
authors.affiliation: Cardiology, Keio University School of Medicine, Tokyo, Japan. veritas@bp.iij4u.or.jp
authors.forename: Takehiro
authors.initials: T
authors.lastname: Kimura
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Miyoshi
authors.forename: Seiji
authors.initials: S
authors.lastname: Takatsuki
authors.forename: Kojiro
authors.initials: K
authors.lastname: Tanimoto
authors.forename: Kotaro
authors.initials: K
authors.lastname: Fukumoto
authors.forename: Kyoko
authors.initials: K
authors.lastname: Soejima
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000818:Animals; D001795:Blood Pressure Determination; D004562:Electrocardiography; D019723:Endoscopes; D004724:Endoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005471:Fluoroscopy; D006439:Hemodynamics; D010535:Laparoscopy / Q000295:instrumentation; D023421:Models, Animal; D010092:Oximetry; D010496:Pericardium / Q000601:surgery*; D015641:Radiography, Interventional; D013552:Swine; D013997:Time Factors