Method Article

A Novel Right Ventricular Volume and Pressure Loaded Piglet Heart Model for the Study of Tricuspid Valve Function.

DOI:

10.3791/61251

⸱

July 28th, 2020

 ,  ,  ,  ,  ,  ,  ,  ,  ,  , 
1Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, 2Department of Surgery, University of Alberta, 3Department of Laboratory Medicine and Pathology, University of Alberta, 4Department of Biomedical Engineering, University of Alberta, 5Department of Civil Engineering, University of Calgary, 6Faculty of Kinesiology, University of Calgary

In This Article

Summary

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A novel recovery piglet heart model with combined pressure and volume overload on the right ventricle is described for the study of tricuspid valve function.

Abstract

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Heart conditions in which the tricuspid valve (TV) faces either increased volume or pressure stressors are associated with premature valve failure. Mechanistic studies to improve our understanding of the underlying pathophysiology responsible for the development of premature TV failure are lacking. Due to the inability to conduct these studies in humans, an animal model is required. In this manuscript, we describe the protocols for a novel chronic recovery infant piglet heart model for the study of changes in the TV when placed under combined volume and pressure stress. In this model, volume loading of the right ventricle and the TV is achieved through the disruption of the pulmonary valve. Then pressure loading is accomplished through the placement of a pulmonary artery band. The success of this model is assessed at four weeks post intervention surgery through echocardiography, intracardiac pressure measurement, and pathologic examination of the heart specimens.

Introduction

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The normal TV functions in a low volume and pressure stress environment. However, there are pediatric and adult heart conditions where the TV is either congenitally malformed or the cardiac physiology is such that the right ventricle and TV are challenged by increased volume (preload) and/or pressure (afterload) stress, such as Tetralogy of Fallot, Ebstein’s anomaly, congenitally corrected transposition of the great arteries, patients with transposition of the great arteries following an atrial switch procedure, idiopathic pulmonary hypertension and hypoplastic left heart syndrome. In these cardiac conditions, the TV is prone to premature valve failure, which in....

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Protocol

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The protocol and procedures in this manuscript were developed under the supervision of a veterinarian and performed in compliance with the guidelines of the Canadian Council on Animal Care and the guide for the care and use of laboratory animals. The protocol was approved by the institutional animal care committee at the University of Alberta. All individuals involved in the manuscript procedures received appropriate biosafety training.

1. Pre-procedure preparation, anesthesia and access

  1. Animal inclusion and exclusion criteria.
    1. Inclusion criteria: Use both female and male Duroc crossbred piglets between four to five ....

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Results

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For model validation, ten piglets (5 male and 5 female) that underwent left thoracotomy with pulmonary valve disruption and placement of pulmonary artery band (intervention group, IP) were compared with ten age and gender-match control piglets that underwent left thoracotomy (control group, CP). At baseline, prior to intervention, all the piglets had either none or trivial pulmonary regurgitation with normal right ventricular geometry and function. There was one piglet in the control group with mild tricuspid regurgitati.......

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Discussion

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During the development of this novel heart model, several considerations have impacted the final model design.

Piglet age and surgical exposure
Prior to formulation of the current piglet model, the team has worked on piglet cadavers ranging from one to six weeks of age with the goal to determine the age range where procedural instrumentation and exposure is adequate. As the surgical procedure required direct echocardiographic guidance, the piglet had to be of the appropr.......

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Disclosures

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The authors have no disclosures.

Acknowledgements

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This research work was supported through generous grant funding provided by the Stollery Children’s Hospital Foundation through the Women and Children’s Hospital Research Institute.

....

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Materials

List of materials used in this article
NameCompanyCatalog NumberComments
Drugs
1% lidocaine sprayWDDC103365Lidodan 30 mL
atropine sodium injectionWDDC/Rafter 8 Products0.5 mg/mL
bupivacaineWDDC/Sterimax5 mg/mL
buprenorphine HCl slow release injectionChiron Compounding Pharmacy1 mg/mL
buprenorphine regularWDDC/Champion Alstoe121378Vetergesic 0.3 mg/mL
cefazolinWDDC/Fresenius Kabi1020161 g/vial
cephalexin capsuleWDDC/NovopharmNovo-Lexin 250 mg/capsule
epinephrineWDDCAdrenalin (1:1000) 1 mg/mL
furosemide tabletWDDC/Novopharm10 mg tablet
Iodine Scrub/SprayCardinal HealthKF22422Betadine brand
ketamine hydrochloride injectionWDDC/Vetoquinol131771Narketan 100 mg/mL
midazolamWDDC/Sandoz1011005 mg/mL
norepinephrineWDDC1 mg/mL
pentobarbital sodiumWDDC/Bimeda-MTC127189Euthanyl 240 mg/mL
ranitidine injectionWDDC25 mg/mL
ranitidine tabletSanis300 mg tablet
Surgical Scrub SpongeStevens333-3774794% CHG Surgical Soap scrub brush
Equipment
24G peripehral IV catheterBDInsyte-N
5Fr double lumen central venous catheterArrowCS-1450220cm
5Fr single lumen umbilical vessel cathetersCovidien/Kendall8888160333Argyle 15 inches
6" Chest retractorRRSMRI
6Fr triple lumen central venous catheterArrowJR-42063-HPHNM20cm
7Fr catheter sheath with flangeDr. Coe custom designed
Adson forcepsRRSMRI
Aestiva/5 VentilatorGE Datex Ohmeda
Atraumatic forcepsTeleflex351865
bioptomeDr. Coe labMansfield Biopsy Forceps
Curved hemostatRRSMRI
Curved mosquito hemostatRRSMRI
Debakey Forceps (Long)Teleflex351804
Debakey Forceps (Narrow)Teleflex351802
Debakey Forceps (Rg)Teleflex351800
Echo probe coverCivco
EndotracheotubeStevens180-112082055Rusch Murphy Eye Low Press. Cuff
Iris Spring scissorsFisher ScientificNC0127560
iSTAT 1 blood gas analyzerAbbott LaboratoriesMN:300-G
iSTAT CG4+ cartridgesAbbott Laboratories03P85-50
Kelly HemostatFine Science Tools1301914
Kocher forcepsRRSMRI
Large Army/Navy RetractorRRSMRI
LaryngoscopeMACO CE Miller#4 BladeLA6226-4Macolaryngoscope.com
Liga-clip applicator LEthiconLC430
Liga-clip applicator MEthiconLX210
Liga-clip applicator SEthiconLX110
Metal suction tipRRSMRI
Metzenbaum Scissors (Lg)RRSMRI
Metzenbaum Scissors (Md)RRSMRI
Mixter - long/mid wideRRSMRI
Mixter - long/narrowRRSMRI
Mixter - long/wideRRSMRI
Mixter - short/narrowRRSMRI
Needle Driver 10"RRSMRI
Needle Driver 6"RRSMRI
Needle Driver 7"RRSMRI
Philips iE33 Echocardiography machinePhilipsX7 and S12 probes
pressure line tubing and 3-way stopcockDr. Freed lab
Rat tooth forcepRRSMRI
silastic reinforced sheetingBioplexusSH-21001-0406" x 8" x .040" Gloss
Small Army/Navy RetractorRRSMRI
Straight hemostatRRSMRI
Straight mosquito hemostatRRSMRI
Sutures: 4-0 and 5-0 synthetic, non-absorbable suture, 2-0 silkDr. Freed lab
Towel clampRRSMRI
vascular tourniquetDr. Freed lab
Weitlaner retractor (Md)RRSMRI
Weitlaner retractor (Sm)RRSMRI
Zoll R Series Monitor DefibrillatorZoll technologies

References

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  1. Bokma, J. P., et al. Severe tricuspid regurgitation is predictive for adverse events in tetralogy of Fallot. Heart. 101 (10), 794-799 (2015).
  2. Wertaschnigg, D., et al.

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Tags

Tricuspid Valve FunctionRight Ventricular LoadingPiglet Heart ModelVolume LoadingPressure LoadingPulmonary Valve DisruptionPulmonary Artery BandEchocardiography AssessmentIntracardiac Pressure MeasurementPathologic Examination
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