eoe sub articles

EoE Sub Articles

All procedures involving animal models have been reviewed by the local institutional animal care committee and the JoVE veterinary review board.

1. Intravascular accesses
NOTE: Intravascular accesses are to be established in the right external jugular vein, the left external jugular vein, left carotid artery, left femoral artery, and right femoral vein. In the pig, the external jugular vein is much larger than the internal jugular vein and, th...

seldinger technique based pulmonary artery catheterization: a procedure to insert pulmonary artery catheter through the jugular vein in a porcine model

Source: Lyhne, M. D., et al. <a href="https://www.jove.com/v/62661">Closed Chest Biventricular Pressure-Volume Loop Recordings with Admittance Catheters in a Porcine Model</a> J. Vis. Exp. (2021).
In this video, we have demonstrated a step-by-step procedure of pulmonary artery catheterization by inserting an intravascular catheter through jugular vein and reach the pulmonary artery to measure the cardiac chamber pressure in porcine model.

<img alt="Figure 1" src="/files/ftp_upload/20830/20830_Figure1.jpg" /> 
Figure 1: Intravascular access guided by ultrasound. (A) Ensure all equipment is ready, sterile, and well-functioning. Necessary equipment includes 7F sheaths (orange), 8F sheaths (blue), and a 12F sheath (white), guidewires for the Seldinger technique, venous catheters for intravascular access, syringe, isotonic saline, scalpel, and suture. (B) Use a linear ultr...

Seldinger Technique Based Pulmonary Artery Catheterization: A Procedure to Insert Pulmonary Artery Catheter Through the Jugular Vein in a Porcine Model

Source: Lyhne, M. D., et al. Closed Chest Biventricular Pressure-Volume Loop Recordings with Admittance Catheters in a Porcine Model J. Vis. Exp. (2021).
...

In pulmonary artery catheterization, a catheter is inserted into a large neck vein and is moved into the heart towards the pulmonary artery to determine cardiac and lung function. To begin, prep an anesthetized pig in the supine position.&#160;
Puncture the skin with an IV catheter and advance it gradually into the jugular vein. Now, replace the needle from the catheter with a guidewire. Subsequently, remove the catheter from the vein. Now, widen the skin incision near the guidewire to place a sheath over it. Remove the guidewire and advance the sheath into the vein to reach the right atrium.
To achieve right heart catheterization, insert through the sheath a Swan Ganz catheter &#8211; a thin tube with a balloon on its distal end. Observe the advancing catheter to ensure the distal part of the catheter is out of the sheath. Using a syringe at the proximal end, inflate the balloon and slowly move the catheter into the right ventricle and the pulmonary artery.
The inflation of the balloon temporarily blocks the pulmonary artery to enable measurement of blood pressure. Subsequently, deflate the balloon and ensure the catheter tip remains in the pulmonary artery to allow cardiopulmonary investigations.&#160;

seldinger-technique-based-pulmonary-artery-catheterization-procedure

Research

JoVE Encyclopedia of Experiments

Biology

Large Animal Models

Porcine

Myocardial Infarction and Functional Outcome Assessment in Pigs

Introduction of newly discovered cardiovascular therapeutics into first-in-man trials depends on a strictly regulated ethical and legal roadmap. One important prerequisite is a good understanding of all safety and efficacy aspects obtained in a large animal model that validly reflect the human scenario of myocardial infarction (MI). Pigs are widely used in this regard since their cardiac size, hemodynamics, and coronary anatomy are close to that of humans. Here, we present an effective protocol for using the porcine MI model using a closed-chest coronary balloon occlusion of the left anterior descending artery (LAD), followed by reperfusion. This approach is based on 90 min of myocardial ischemia, inducing large left ventricle infarction of the anterior, septal and inferoseptal walls. Furthermore, we present protocols for various measures of outcome that provide a wide range of information on the heart, such as cardiac systolic and diastolic function, hemodynamics, coronary flow velocity, microvascular resistance, and infarct size. This protocol can be easily tailored to meet study specific requirements for the validation of novel cardioregenerative biologics at different stages (i.e. directly after the acute ischemic insult, in the subacute setting or even in the chronic MI once scar formation has been completed). This model therefore provides a useful translational tool to study MI, subsequent adverse remodeling, and the potential of novel cardioregenerative agents.

This protocol describes the porcine myocardial infarction (MI) model using a 90 min closed-chest coronary balloon occlusion of the left anterior descending artery (LAD), followed by reperfusion. Furthermore, the protocol for several outcome parameters, such as cardiac function, hemodynamics, microvascular resistance, and infarct size, are also presented.

Introduction of newly discovered cardiovascular therapeutics into first-in-man trials depends on a strictly regulated ethical and legal roadmap. One ...

JoVE Journal

Medicine

Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction

Mortality after acute myocardial infarction remains substantial and is associated with significant morbidity, like heart failure. Novel therapeutics are therefore required to confine cardiac damage, promote survival and reduce the disease burden of heart failure. Large animal experiments are an essential part in the translational process from experimental to clinical therapies. To optimize clinical translation, robust and representative outcome measures are mandatory. The present manuscript aims to address this need by describing the assessment of three clinically relevant outcome modalities in a pig acute myocardial infarction (AMI) model: infarct size in relation to area at risk (IS/AAR) staining, 3-dimensional transesophageal echocardiography (TEE) and admittance-based pressure-volume (PV) loops. Infarct size is the main determinant driving the transition from AMI to heart failure and can be quantified by IS/AAR staining. Echocardiography is a reliable and robust tool in the assessment of global and regional cardiac function in clinical cardiology. Here, a method for three-dimensional transesophageal echocardiography (3D-TEE) in pigs is provided. Extensive insight into cardiac performance can be obtained by admittance-based pressure-volume (PV) loops, including intrinsic parameters of myocardial function that are pre- and afterload independent. Combined with a clinically feasible experimental study protocol, these outcome measures provide researchers with essential information to determine whether novel therapeutic strategies could yield promising targets for future testing in clinical studies.

Reliable and accurate outcome assessment is the key for translation of preclinical therapies into clinical treatment. The current paper describes how to assess three clinically relevant primary outcome parameters of cardiac performance and damage in a pig acute myocardial infarction model.

Mortality after acute myocardial infarction remains substantial and is associated with significant morbidity, like heart failure. Novel therapeutics are ...

Induction and Phenotyping of Acute Right Heart Failure in a Large Animal Model of Chronic Thromboembolic Pulmonary Hypertension

The development of acute right heart failure (ARHF) in the context of chronic pulmonary hypertension (PH) is associated with poor short-term outcomes. The morphological and functional phenotyping of the right ventricle is of particular importance in the context of hemodynamic compromise in patients with ARHF. Here, we describe a method to induce ARHF in a previously described large animal model of chronic PH, and to phenotype, dynamically, right ventricular function using the gold standard method (i.e., pressure-volume PV loops) and with a non-invasive clinically available method (i.e., echocardiography). Chronic PH is first induced in pigs by left pulmonary artery ligation and right lower lobe embolism with biological glue once a week for 5 weeks. After 16 weeks, ARHF is induced by successive volume loading using saline followed by iterative pulmonary embolism until the ratio of the systolic pulmonary pressure over systemic pressure reaches 0.9 or until the systolic systemic pressure decreases below 90 mmHg. Hemodynamics are restored with dobutamine infusion (from 2.5 &#181;g/kg/min to 7.5 &#181;g/kg/min). PV-loops and echocardiography are performed during each condition. Each condition requires around 40 minutes for induction, hemodynamic stabilization and data acquisition. Out of 9 animals, 2 died immediately after pulmonary embolism and 7 completed the protocol, which illustrates the learning curve of the model. The model induced a 3-fold increase in mean pulmonary artery pressure. The PV-loop analysis showed that ventriculo-arterial coupling was preserved after volume loading, decreased after acute pulmonary embolism and was restored with dobutamine. Echocardiographic acquisitions allowed to quantify right ventricular parameters of morphology and function with good quality. We identified right ventricular ischemic lesions in the model. The model can be used to compare different treatments or to validate non-invasive parameters of right ventricular morphology and function in the context of ARHF.

We present a protocol to induce and phenotype an acute right heart failure in a large animal model with chronic pulmonary hypertension. This model can be used to test therapeutic interventions, to develop right heart metrics&#160;or to improve the understanding of acute right heart failure pathophysiology.

The development of acute right heart failure (ARHF) in the context of chronic pulmonary hypertension (PH) is associated with poor short-term outcomes. The ...

Seldinger Technique Based Pulmonary Artery Catheterization: A Procedure to Insert Pulmonary Artery Catheter Through the Jugular Vein in a Porcine Model

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