Radio frequency heating of chronic ovine infarct leads to sustained infarct area and ventricular volume reduction Mark B. Ratcliffe, MDa, Arthur W. Wallace,

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Presentation transcript:

Radio frequency heating of chronic ovine infarct leads to sustained infarct area and ventricular volume reduction Mark B. Ratcliffe, MDa, Arthur W. Wallace, MD, PhDb, John R. Teerlink, MDc, James Hong, MSa, Ali Salahieh, BSa, Sang-Hyun Sung, MD, PhDa, Edmund C. Keung, MDc, Randall J. Lee, MD, PhDc The Journal of Thoracic and Cardiovascular Surgery Volume 119, Issue 6, Pages 1194-1204 (June 2000) DOI: 10.1067/mtc.2000.105826 Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 1 Schema of an experimental animal RF heating of LV infarct. An array of sonomicrometry crystals (Sono crystals) was place on the anterior (crystals 1-5 ), lateral (crystals 6-9 ), and inferior (crystals 10-12 ) epicardial surfaces of the LV. An echo probe (Echo) was inserted into the abdomen through a subxiphoid incision and a transdiaphragmatic long axis of the LV was obtained. The LV infarct was heated with a handheld radio frequency (RF) probe. Ao, Aorta; LV, left ventricle; LA, left atrium. The Journal of Thoracic and Cardiovascular Surgery 2000 119, 1194-1204DOI: (10.1067/mtc.2000.105826) Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 2 A close-up picture of the handheld RF probe. A thermocouple measures epicardial temperature during heating. The Journal of Thoracic and Cardiovascular Surgery 2000 119, 1194-1204DOI: (10.1067/mtc.2000.105826) Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 3 The acute effect of RF heating on end-systolic elastance (EES) and diastolic compliance. A, Comparison of EES before and after RF heating. B, Comparison of diastolic compliance before and after RF heating. LV volume is calculated from sonomicrometry array data (LVVsono). The volume intercept but not the slope of EES was significantly different after treatment. Diastolic compliance was not significantly different after treatment. Degradation of sonomicrometry signals precluded calculation of pressure-volume relationships at 10 weeks. *P < .001 (difference in LV volume intercept). The Journal of Thoracic and Cardiovascular Surgery 2000 119, 1194-1204DOI: (10.1067/mtc.2000.105826) Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 4 Histologic studies of infarcts immediately after and 10 weeks after RF infarct heating. A, Immediately after RF heating, coagulated protein in the infarct appears brown to purple on van Gieson stain. Note that evidence of RF heating (RF) extends approximately 50% of the way through the infarct wall into the deep dense collagen layer. Sham-operated control (B) and RF heat/patch animals (C) are shown at 10 weeks. The sham control shows the normal infarct architecture with a loose superficial collagen layer with abundant adipocytes (A) and a deep dense collagen layer. The treated section shows patch remnants (P) and a thin capsule (C). The superficial collagen layer is now composed of dense collagen (DC). The deep layers in the sham-operated control and treatment sections are similar. Epi, Epicardium; Endo, endocardium; VVG, van Gieson; PAS, periodic acid–Schiff. The Journal of Thoracic and Cardiovascular Surgery 2000 119, 1194-1204DOI: (10.1067/mtc.2000.105826) Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 5 Effect of RF heating without patch (RF heat/no patch) on the infarct area in a single representative animal (infarct triangle 9-5-4). Note that the infarct area is acutely decreased but redilates over the next several weeks. The Journal of Thoracic and Cardiovascular Surgery 2000 119, 1194-1204DOI: (10.1067/mtc.2000.105826) Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 6 Effect of RF heating and patch (RF heat/patch) on end-diastolic infarct area. In each case the treated group is in orange and the sham control is in dark red. RF heating acutely decreased end-diastolic infarct area by 34%. The effect was maintained at 10 weeks. End-systolic infarct area is not shown but was nearly identical. aP = .0002; bP = .0002. The Journal of Thoracic and Cardiovascular Surgery 2000 119, 1194-1204DOI: (10.1067/mtc.2000.105826) Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 7 Effect of RF heating and patch (RF heat/patch) on LV volume. A, Effect on end-diastolic LV volume. B, Effect on end-systolic LV volume. In each case the treated group is in orange and the sham control is in dark red. RF heating decreased end-diastolic and end-systolic LV volume by 20% and 32%, respectively. Both end-diastolic and end-systolic volume reduction were maintained at 10 weeks. Note the continued adverse remodeling in the sham-operated controls. aP = .007; bP = .008. The Journal of Thoracic and Cardiovascular Surgery 2000 119, 1194-1204DOI: (10.1067/mtc.2000.105826) Copyright © 2000 Mosby, Inc. Terms and Conditions