title: Echocardiography-guided percutaneous per-ventricular laser ablation of ventricular septum: in vivo study in a canine model.
abstract: Surgical myectomy and ethanol ablation are established intervention strategies for left ventricular outflow obstruction in hypertrophic cardiomyopathy. Safety and efficacy limitations of these interventions call for a minimally invasive, potentially safer, and more efficacious strategy. In this study, we aimed to evaluate the feasibility of echocardiography-guided percutaneous per-ventricular laser ablation of a ventricular septum in a canine model. Six domestic dogs were chosen for the study. A 21G needle was inserted into the right ventricle with its tip reaching the targeted basal to mid-septum, after which laser ablation was performed as follows: 1-W laser for 3 min (180 J) at the basal segment and 5 min (300 J) at middle segment of the septum, respectively. Echocardiography, blood chemistry tests, and pathology examination were performed to assess the results of laser ablation. No death or major complications, i.e., tamponade, pericardial effusion, or ventricular fibrillation, occurred. The laser-ablated areas were well demarcated in the results of the pathological examination. The diameters of the ablated regions were 4.42 ± 0.57 and 5.28 ± 0.83 mm for 3 and 5 min ablation, respectively. Pre-ablation and post-ablation, cardiac enzymes were found to increase significantly while no significant differences were found among M-mode, 2D (LVEF), pulsed-wave (PW) Doppler, and tissue Doppler imaging (TDI) measurements. Contrast echocardiography confirmed the perfusion defects in the ablated regions. Microscopically, the ablated myocardium showed coagulative changes and a sparse distribution of disappearing nuclei and an increase in eosinophil number were observed. Our study suggests that percutaneous and per-ventricular laser ablation of the septum is feasible, potentially safe and efficacious, and warrants further investigation and validation.
authors: Ultrasound Department, Xijing Hospital, Fourth Military Medical University, Changle West Road 15 Hao, Xi'an, ShaanXi Province, 710032, China.
authors: Guangbin
authors: G
authors: He
authors: Ultrasound Department, Xijing Hospital, Fourth Military Medical University, Changle West Road 15 Hao, Xi'an, ShaanXi Province, 710032, China.
authors: Chao
authors: C
authors: Sun
authors: Ultrasound Department, Xijing Hospital, Fourth Military Medical University, Changle West Road 15 Hao, Xi'an, ShaanXi Province, 710032, China.|Ultrasound Department, Ningxia Medical University, Yin Chuan, China.
authors: Xiangkong
authors: X
authors: Zhang
authors: Ultrasound Department, Xijing Hospital, Fourth Military Medical University, Changle West Road 15 Hao, Xi'an, ShaanXi Province, 710032, China.
authors: Lei
authors: L
authors: Zuo
authors: Ultrasound Department, Xijing Hospital, Fourth Military Medical University, Changle West Road 15 Hao, Xi'an, ShaanXi Province, 710032, China.
authors: Haiying
authors: H
authors: Qin
authors: Ultrasound Department, Xijing Hospital, Fourth Military Medical University, Changle West Road 15 Hao, Xi'an, ShaanXi Province, 710032, China.
authors: Minjuan
authors: M
authors: Zheng
authors: Ultrasound Department, Xijing Hospital, Fourth Military Medical University, Changle West Road 15 Hao, Xi'an, ShaanXi Province, 710032, China. zhouxd@fmmu.edu.cn.
authors: Xiaodong
authors: X
authors: Zhou
authors: Ultrasound Department, Xijing Hospital, Fourth Military Medical University, Changle West Road 15 Hao, Xi'an, ShaanXi Province, 710032, China. liuliwen@fmmu.edu.cn.
authors: Liwen
authors: L
authors: Liu
mesh_terms: D000818:Animals; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D004285:Dogs; D004452:Echocardiography; D053685:Laser Therapy; D053844:Lasers, Solid-State; D025321:Surgery, Computer-Assisted; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D054088:Ventricular Septum / Q000601:surgery
keywords: Echocardiography; Intervention; Laser ablation; Per-ventricular; Percutaneous; Septum