JP6421315B2 - Model animal capable of visually observing the heart and method for producing the same - Google Patents

Model animal capable of visually observing the heart and method for producing the same Download PDF

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JP6421315B2
JP6421315B2 JP2016014022A JP2016014022A JP6421315B2 JP 6421315 B2 JP6421315 B2 JP 6421315B2 JP 2016014022 A JP2016014022 A JP 2016014022A JP 2016014022 A JP2016014022 A JP 2016014022A JP 6421315 B2 JP6421315 B2 JP 6421315B2
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internal thoracic
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rib
vein
artery
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中島 博
中島  博
康夫 原
康夫 原
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中島 博
中島 博
株式会社アイビーテック
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  The present invention relates to a model animal capable of actually observing the heart in a pulsating state with the naked eye, and a method for producing the model animal. The present invention relates to a method for producing a model animal that can shorten the time required for producing the animal.

As a technique for visualizing the structure of the heart, an imaging technique for imaging a two-dimensional section of the heart, such as ultrasound scanning, cardiac ultrasound, and transthoracic echocardiogram (TTE), is known.
Regarding cardiac surgery such as lead implantation of a cardiac pacemaker, it is performed while imaging the actual state of the heart and blood vessels based on such a two-dimensional image.

  For example, Japanese Unexamined Patent Publication No. 2014-528333 (Patent Document 1) renders a part of a model because it requires skill to image the pulsation state of a heart and the three-dimensional state of a blood vessel from a two-dimensional perspective image. Thus, it is proposed that cross-sectional images are formed, a doctor forms mental images of anatomical structures, and these imaging images are converted into 3D information.

On the other hand, in the field of cardiac surgery, development of a highly accurate heart simulator is required from the viewpoint of medical training for young doctors. In response to such a request, for example, Japanese Translation of PCT International Publication No. 2015-507225 (Patent Document 2) describes a contraction of the ventricle and the atrium using a pneumatically pressurized chamber as a simulator for training a surgical procedure. Proposed systems have been created that replicate the pumping action of the human heart.
Dry laboratories that use such artificial heart simulators are less expensive than wet laboratories that use the heart of animals such as pigs to learn their skills, and can be used to learn techniques in any environment. Are better.

  However, in an actual thoracotomy, the position of the heart on which the operation is performed may deviate from the original position before the thoracotomy due to muscle resection or blood vessel movement. In addition, the size and shape of the heart may change between the heart taken out of the body and the heart beating in the body.

  For this reason, there are cases where the two-dimensional fluoroscopic image does not match the heart that is actually operated, and it becomes more difficult to image the heart condition being operated from the fluoroscopic image, and skill is required. If you want to observe heart pulsation, blood vessel changes, etc. when a disease treatment device is attached to the heart, such as a cardiac pacemaker, implantable cardioverter defibrillator or stent, use an artificial heart model. The medical system and medical device used are insufficient.

  For these reasons, it is important to confirm the effects on the pulsation state and blood vessels of the heart during surgery, or the operation of the device when a heart disease treatment device such as an implantable cardioverter defibrillator or stent is attached. There is a strong demand for observing with the naked eye with the heart beating.

As a model for observing the state of the heart that is actually beating in the body, there is a production of a model animal.
For example, in medical research such as circulatory system and organ transplantation, drug development for circulatory system diseases, confirmation of efficacy, etc., primates that are animals close to humans, especially medium-sized and large-sized animals such as pigs, dogs and monkeys A pathological model closer to a clinical pathological condition using a mammal and a method for producing the same have been proposed (for example, JP 2002-209473 A, WO 2006/030737).

Special table 2014-528333 gazette Special table 2015-507225 gazette JP 2002-209473 A WO2006 / 030737

  However, since the method for producing a heart disease model proposed in Patent Documents 3 and 4 has undergone thoracotomy, arterial ligation or equivalent highly invasive treatment, the model animal has a high lethality rate, There is a problem that there is a large variation in pathological models. Development of a method for producing a model animal with little variation and a low lethality is desired for development of a device for treating heart disease and medical training.

  The present invention has been made in view of the circumstances as described above, and an object thereof is a model animal for visualizing a heart produced by an operation involving thoracotomy, both during and after the operation. An object of the present invention is to provide a method for producing a model animal that can reduce mortality and prolong survival time.

The main cause of shortening the survival time of model animals that have opened their chests is a decrease in blood pressure due to massive bleeding. Since the arteries and veins inside the sternum are difficult to see due to the ribs and intercostal muscles, the arteries and veins may be cut during thoracotomy, which causes massive bleeding.
The operation of cutting and removing the ribs without damaging these blood vessels is not easy, and it takes time to cut the ribs while confirming the position of the blood vessels, making it difficult to produce a model animal with an open chest.

  In order to reduce the risk of bleeding, the present inventors have studied various thoracotomy methods, found a thoracotomy method completely different from the conventional one, and completed a method for producing a model animal of the present invention with a low lethality rate. . In addition, the method for producing a model animal of the present invention completes a model animal that has a longer survival time than before and that has almost no heart displacement or shape change before and after surgery and that can be observed with the naked eye. did.

The method for producing a model animal of the present invention is a method for producing a model animal capable of observing the heart beating in the body with the naked eye, wherein the animal is a medium-sized mammal excluding humans,
Peeling the pleura from the pericardium through an opening formed beside the xiphoid process;
Ligating the head side of the internal thoracic vein and internal thoracic artery and then ligating the ventral sides of the internal thoracic vein and internal thoracic artery to stop the internal thoracic vein and internal thoracic artery; and 5 steps from the fifth rib to the second rib, while cutting the intercostal artery and intercostal vein of each rib while bleeding.

In the step of peeling the pleura from the pericardium, it is preferable that the internal thoracic vein and the internal thoracic artery are kept away from the sternum together with the pleura.
Moreover, it is preferable to peel the pleura while separating the thoracic joint of the second rib from the fifth rib.

Ligation of the internal thoracic vein and internal thoracic artery is performed by confirming the exposure of the internal thoracic vein and internal thoracic artery.
In the method for producing a model animal of the present invention, the rib can be excised from the inside of the rib body.

The model animal of the present invention is a model animal in which at least a part of the chest wall is excised and the heart beating in the body can be observed with the naked eye, and the animal is a medium-sized mammal excluding a human, The fifth rib is cut off from the sternum from the rib, the pleura is detached from the pericardium, and the internal thoracic vein and the internal thoracic artery are ligated.

  In the model animal of the present invention, the heart position is almost the same as that before the thoracotomy, and the second to fifth ribs are preferably excised from the thoracic rib joint. The animal is preferably a pig.

According to the method for producing a model animal of the present invention, thoracotomy can be performed without incurring the risk of massive bleeding. And, by such a minimally invasive surgery with a low lethality, it is possible to provide a model animal that can visualize a beating heart in almost the same state as before the surgery.
Since the model animal of the present invention has almost no influence on the heart due to thoracotomy, it has a longer lifespan than the conventional thoracotomy model animal.

It is a schematic diagram for demonstrating the main blood vessels of a chest. FIG. 6 is a horizontal cutaway view for explaining the positional relationship among the heart, ribs, internal thoracic artery, and internal thoracic vein. It is a flowchart for demonstrating one Embodiment of the production method of the model animal of this invention. It is a figure for demonstrating an incision process. It is the schematic diagram which showed the state after a thoracotomy joint separation. It is sectional drawing of the horizontal direction of the chest for demonstrating the state after a pectoral-knot joint parting. It is the schematic diagram showing the chest part of one Embodiment of the model animal of this invention. It is the schematic diagram showing the chest part of other embodiment of the model animal of this invention.

[Model animal production method]
The method for producing a model animal of the present invention comprises:
Peeling the pleura from the pericardium through an opening formed beside the xiphoid process;
Ligating the head side of the internal thoracic vein and internal thoracic artery and then ligating the ventral sides of the internal thoracic vein and internal thoracic artery to stop the internal thoracic vein and internal thoracic artery; and It includes a step of excising from the fifth rib to the second rib while hemostasis the intercostal artery and intercostal vein of each rib.

Before explaining a specific technique, blood vessels in the chest will be explained based on FIGS. 1 and 2.
FIG. 1 is a schematic diagram for explaining main blood vessels in the chest, and FIG. 2 is a cutaway view in the horizontal direction of the chest for explaining the positional relationship among the heart, ribs, internal thoracic artery, and internal chest vein. .

As shown in FIG. 2, the heart is protected by the ribs.
As shown in FIG. 1, the ribs are articulated from the first rib 1 to the seventh rib 7 called rib cartilage to the sternum. Specifically, the first rib 1 is connected to the sternum, and the second rib 2, the third rib 3, the fourth rib 4, the fifth rib 5, the sixth rib 6, and the seventh rib 7 are connected to the sternum body. Directly linked. The eighth to tenth ribs are connected to the auxiliary cartilage. These ribs are covered with muscles (not shown) such as intercostal muscles, and the internal thoracic artery and internal thoracic vein are in a state of being embedded in these muscles.

By the way, in order to create a model that can visualize the heart, it is necessary to excise part of the rib at the corresponding position of the heart, but it is important that the internal thoracic artery and internal thoracic vein are not damaged in the excision of the rib. It is.
That is, as shown in FIG. 1, the internal thoracic artery is connected to the thoracic aorta via the brachiocephalic artery (subclavian artery), and the internal thoracic vein is connected to the superior vena cava. In addition, intercostal artery and intercostal vein run through each rib, intercostal artery is connected to thoracic aorta and internal thoracic artery, and intercostal vein is connected to internal thoracic vein and superior vena cava.
Blood from the thoracic aorta and intercostal artery is supplied to the internal thoracic artery, and the intercostal vein is connected to the internal thoracic vein, and a part of the blood in the internal thoracic vein is sent to the superior vena cava. Therefore, if the internal thoracic artery or internal thoracic vein is cut, it may cause major bleeding.

  The model production method of the present invention is characterized in that the internal thoracic artery, internal thoracic vein, intercostal artery, and intercostal vein are processed without causing major bleeding. That is, first, the head side, which is the connection point between the brachiocephalic artery (subclavian artery) and the superior vena cava of the internal thoracic artery and internal thoracic vein, is ligated (marked with “x” in the figure), and the internal thoracic artery After blocking the blood flow that flows into the ventricle, the ventral ends of the internal thoracic artery and internal thoracic vein are ligated and separated. After preventing massive bleeding due to cutting of the internal thoracic artery and internal thoracic vein, it is sufficient to process each intercostal artery and intercostal vein at the time of thoracotomy and rib excision, so that the operation for opening the chest is simplified.

Hereinafter, an embodiment of the manufacturing method of the present invention will be described based on the flowchart of FIG.
Examples of animals to which the method for producing a model animal of the present invention is applied include medium-sized mammals such as dogs, pigs, monkeys, and preferably pigs. This is because the pig heart is approximately the size of a human heart.

  At the time of thoracotomy, first, an incision is made in the side part of the xiphoid process (step # 1). FIG. 4 shows a state in which the side portion of the xiphoid process is incised with the pig lying on its back. The xiphoid process can be confirmed from the incision.

  In a conventional thoracotomy, the intercostal space is usually incised along the sternum or in a minimally invasive manner in a human thoracotomy. The method of the present invention is characterized in that the side part of the xiphoid process, which is the tip part below the sternum, is incised first.

As shown in FIG. 2, at the area of the xiphoid process, the pericardium that wraps the heart and the pleura that wraps and protects the lungs are peeled off to create a small space S that allows a finger to pass through. An incision is made on the side of the xiphoid process, a finger is passed through the space, and the pleura is peeled off from the pericardium using the base as a base (step # 2).
The pleura is peeled away from the heart, that is, pushing the pleura to the lung side. The pericardium and pleura can be peeled off with a finger or the like if there is a base portion.

  Pleural detachment is performed while the incision is advanced toward the sternum along the sternum. By removing the rib cage joint in order from the fifth rib to the second rib, the pleura can be detached from the pericardium and pushed toward the lung side.

  The first rib is cut off at the cartilage near the sternum. In this way, the fifth rib to the first rib are separated from the sternum body. FIG. 5 shows a state where the first rib 1 to the fifth rib 5 are separated from the sternum body. In FIG. 5, the ribs on the right side are separated.

In addition, although there is no particular limitation on the method of separating the rib cage joint and the first rib, the cartilage portion on the sternum head side is separated from the muscle with an electric knife and cut with a bone scissors. be able to. The cut surface is preferably hemostatic with bone wax. These operations make it easier to observe the inner surface of the chest cavity.
After making the inside of the thoracic cavity easy to observe, the internal thoracic artery and internal thoracic vein are processed (step # 3).

FIG. 6 is a schematic diagram showing the positional relationship of the heart, lungs, internal thoracic artery, and internal thoracic vein on the horizontal cut surface of the rib portion from which the intercostal joint has been separated.
As the pleura is detached from the pericardium and pushed to the lung side, the internal thoracic artery and internal thoracic vein, which have become difficult to see with the ribs and intercostal muscles, are moved to the lung side along with the pleura, Torn apart. When the inside of the thoracic cavity is observed from the first rib side, the internal thoracic artery and internal thoracic vein that are separated from the rib can be confirmed. The internal thoracic artery and internal thoracic vein in this region are in the vicinity of the connection start point with the brachiocephalic artery (subclavian artery) and descending vena cava (superior vena cava). Therefore, the inflow of blood from the brachiocephalic artery (subclavian artery) to the internal thoracic artery and the inflow of blood from the internal thoracic vein to the superior vena cava are performed by ligating and separating the internal thoracic artery and internal thoracic vein. Can be cut off.

Next, the abdominal ends of the internal thoracic artery and internal thoracic vein are ligated and separated (step (ii) in step 3).
The chest wall removal part is determined, and the rectus sheath of the rectus abdominis is removed manually. The rectus abdominis muscle is a muscle that runs straight from the 5th to the 7th ribs to the pubic bone, and the internal thoracic artery and internal thoracic vein run between the rectus abdominis muscles and are therefore attached to the pleura. The internal thoracic veins and internal thoracic arteries that have been applied to the lungs are exposed on the rib surface as the rectus abdominis muscles are pulled out. When the abdominal ends of the internal thoracic artery and internal thoracic vein are confirmed in this way, they are ligated and separated.

After ligation and separation of the internal thoracic artery and internal thoracic vein, only the intercostal artery and vein are responsible for the blood flow path to the chest wall. Next, the ribs are removed and the chest wall is removed sequentially from the fifth rib side (step # 4). Depending on the determined chest wall removal unit, muscles such as the rectus abdominis muscle, the front saw blade muscle, and the transverse abdominis muscle are processed.
It should be noted that when the rectus abdominis muscle is cut off, the internal thoracic artery on the abdominal side, the internal thoracic vein, and the ligation operation may be complicated, the venous vein may be complicated, and attention should be paid to these cuts and bleeding.

  As shown in FIG. 6, since the thoracic rib joint is separated, each rib can be cut from the thoracic cavity side (arrow side in FIG. 6) by expanding the ribs.

By incising the lower edge of the chest wall removal portion with an electric knife and cutting the transverse abdominal muscle following the rectus abdominis muscle, the chest wall covered with the anterior saw blade can be exposed.
From the lower rib edge, observe the thoracic cavity and confirm the diaphragm level. As a result, the auxiliary cartilage of the lower ribs (fifth and sixth ribs) including the anterior saw blade on the head side is cut off with an electric knife or the like.
The ribs are disconnected while hemostasis is performed in the intercostal artery and intercostal vein. Intercostal arteriovenous hemostasis is performed by ligation in principle.

  Conventionally, the internal thoracic artery and internal thoracic vein have been difficult to check with the intercostal muscles, etc., and there is a risk of cutting the internal thoracic artery and internal thoracic vein when cutting the ribs, which is the cause of major bleeding. It was. In the surgical method of the present invention, since the ligation processing of the internal thoracic vein and the internal thoracic artery running in the vicinity of the sternum has been completed by the above operation, the rib can be cut with the risk of major bleeding reduced. .

  Then, the rib can be excised while directly confirming the inside of the thoracic cavity.

With the above operation, the chest wall on one side (the right side in FIGS. 4 to 6) can be removed. After the ribs are removed, pleural treatment and body surface treatment are performed as necessary (step # 5).
The skin of the chest wall is preferably trimmed and sewn so as to cover the edge of the chest cavity opening as much as possible. The pleura may be left as a membrane covering the lungs or may be excised. When excised, the lungs can be visually observed along with the heart.

  FIG. 7 shows a chest part of a model animal in which the right side is opened by the production method of the present invention and the heart can be visually confirmed.

If necessary, the chest walls on both sides are excised (step # 6). The remaining one side can be excised by repeating Step # 2 to Step # 5.
What is necessary is just to decide the side (right or left) of a chest wall resection and both sides according to the intended purpose of the model to produce.

As described above, according to the production method of the present invention, the rib can be removed with the risk of cutting the internal thoracic vein and internal thoracic artery reduced as much as possible. Can be shortened.
In addition, since the ribs are excised after the pleura is detached from the pericardium, a model animal can be produced with almost no influence of thoracotomy on the heart including the pericardium.
Therefore, the blood vessels connected to the heart (coronary arteries, pulmonary arteriovenous, ascending aorta, inferior vena cava, superior vena cava) and the heart itself in the created model animal are hardly affected by thoracotomy. Therefore, the heart position and heart shape can be beaten while maintaining the original position and shape before the thoracotomy.

In addition, since blood loss during thoracotomy is reduced, blood pressure reduction due to massive bleeding has been
For example, although it suppressed by drugs, such as a blood pressure raising agent, in the preparation method of this invention, the usage-amount of these chemical | medical agents can be made unnecessary.
During the thoracotomy as described above, the blood pressure may decrease due to the evaporation of the body fluid after the operation.

[Model animal]
The model animal of the present invention is a model animal for observing the heart in the same state as when the heart is present in the body with the naked eye. The model animal of the present invention is preferably produced from the production method of the present invention.

FIG. 7 is a schematic diagram showing a chest portion of a model animal that allows the right chest to be observed by the production method of the present invention.
In FIG. 7, the right side of the chest wall is excised, and the right side of the heart (right atrium, right ventricle) and the right lung can be observed with the naked eye.
The model animal of the present invention has the following characteristics.
(I) The first to fifth ribs are cut and removed from the sternum. That is, the ribs remaining connected to the sternum are the sixth rib and the seventh rib. The 8th to 10th ribs are left connected to the 6th and 7th ribs.
The second rib to the fifth rib are preferably removed from the thoracic rib joint, but are not limited thereto.

(Ii) The pleura is detached from the pericardium. The peeled pleura may be in a state of being pushed toward the lungs, or may be removed by separation. If the pleura has been removed, the lungs can be visually confirmed.
(Iii) The internal thoracic vein and internal thoracic artery are ligated in the vicinity of the origin and stop.

  The heart position is approximately the same as before the thoracotomy. Since the pericardium is peeled off from the pleura in thoracotomy, no special treatment is performed, so that the state before the thoracotomy is substantially maintained. Coronary arteries are also not involved in thoracotomy. Therefore, in the model animal of the present invention, by continuing positive pressure ventilation, the heart beats in almost the same state as before the excision even though the chest wall and ribs are excised.

Thus, the model animal of the present invention is a model animal that can visually observe the heart in a state that is substantially the same as the state of beating in the body. According to such a model animal, a fluoroscopic image obtained by X-rays matches an actual heart image that can be observed with the naked eye.
In the model animal of the present invention, it is possible to simultaneously observe a two-dimensional fluoroscopic image obtained by X-ray fluoroscopy used in many cardiac interventions and an actual three-dimensional heart that can be observed with the naked eye. It can be used as a training tool for medical personnel to image an actual heart beat state from a two-dimensional image.

In particular, the lead of cardiac pacemakers and implantable cardioverter defibrillators (conductors that transmit the electrical activity of the heart to the sensing circuit) are usually set in the right atrium and right ventricle, so as a training tool for lead insertion A model animal whose right side is opened is preferably used. In the model animal with the right chest wall excised, the influence of the heart at the time of lead insertion, the state of pulsation change, etc. can be observed with the naked eye.
On the other hand, catheter treatment such as stent attachment for the treatment of myocardial infarction and angina is often performed on the left atrium and left ventricle side of the coronary artery and ascending aorta. Therefore, for training such as attaching a stent to the heart and inflating with a balloon, a model animal from which the left chest wall is removed is preferably used so that the left heart can be confirmed. Also, since the left ventricular lead used in cardiac resynchronization therapy is placed on the surface of the left ventricle, it is preferable to use a model animal whose left side is opened.

  Further, as shown in FIG. 8, a model animal in which both sides of the chest are excised may be used in order to cope with various cardiac surgeries.

  Conventionally, a model animal that has undergone thoracotomy died at most in about 2 hours. However, in the model animal of the present invention, since the influence on the heart during thoracotomy is reduced as much as possible, depending on the type of animal, In the case of pigs, survival of 6 hours or more was confirmed. Therefore, since a plurality of medical workers can be engaged in training, the utility value as a model animal is high.

  Since the model animal of the present invention can be observed with the naked eye in almost the same state as when the heart is beating in the body, image training of a three-dimensional actual heart state from a two-dimensional perspective image, lead implantation of a cardiac pacemaker, It can be suitably used for training tools such as catheter surgery, operation confirmation of heart treatment devices such as stents, defibrillators, and cardiac pacemakers. Further, according to the method for producing a model animal of the present invention, a model animal for heart observation can be produced efficiently with a low lethality rate.

DESCRIPTION OF SYMBOLS 1 1st rib 2 2nd rib 3 3rd rib 4 4th rib 5 5th rib 6 6th rib 7 7th rib

Claims (10)

  1. A method for producing a model animal that can observe the heart beating in the body with the naked eye,
    The animal is a medium-sized mammal excluding humans,
    Peeling the pleura from the pericardium through an opening formed beside the xiphoid process;
    Ligating the head side of the internal thoracic vein and internal thoracic artery and then ligating the ventral sides of the internal thoracic vein and internal thoracic artery to stop the internal thoracic vein and internal thoracic artery; and Excising 5 ribs to 2nd ribs while hemostasis the intercostal artery and intercostal vein of each rib;
    A method for producing a model animal comprising
  2.   The method for producing a model animal according to claim 1, wherein, in the step of peeling the pleura from the pericardium, the internal thoracic vein and the internal thoracic artery are moved away from the sternum together with the pleura.
  3.   The method for producing a model animal according to claim 2, wherein the pleura is detached while the thoracic joint of the second rib is dissected from the fifth rib.
  4.   The ligation on the head side of the internal thoracic vein and internal thoracic artery is performed by exposing the internal thoracic vein and internal thoracic artery by cartilage resection near the sternum of the first rib. Of producing a model animal.
  5.   The ventral ligation of the internal thoracic vein and internal thoracic artery is performed by exposing the internal thoracic vein and internal thoracic artery by pulling out the rectus abdominis muscle. Manufacturing method.
  6.   The method for producing a model animal according to claim 1, wherein the rib is excised from the inside of the rib body.
  7. A model animal in which at least part of the chest wall has been removed and the heart beating in the body can be observed with the naked eye,
    The animal is a medium-sized mammal excluding humans,
    The first to fifth ribs have been cut off from the sternum,
    A model animal in which the pleura is detached from the pericardium and the internal thoracic vein and internal thoracic artery are ligated.
  8.   The model animal according to claim 7, wherein the heart position is substantially the same as that before the thoracotomy.
  9.   The model animal according to claim 7 or 8, wherein the second to fifth ribs are excised from the thoracic rib joint.
  10. The model animal according to any one of claims 7 to 9, wherein the animal is a pig.
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EP1169693A2 (en) * 1999-03-02 2002-01-09 Peter Yong Thoracic training model for endoscopic cardiac surgery
JP2002209473A (en) * 2001-01-19 2002-07-30 Biophenix:Kk Wide-range pathologic model animal of cardiac infarction, method for preparing the same and method for screening drug using the same model animal
EP1808071A4 (en) * 2004-09-13 2009-05-13 Noboru Teramoto Construction of arterial occlusive disease animal model
JP2009507522A (en) * 2005-06-23 2009-02-26 メドトロニック バスキュラー インコーポレイテッドMedtronic Vascular,Inc. Method and system for treating damaged heart tissue
JP5689597B2 (en) * 2009-11-04 2015-03-25 テルモ株式会社 Method for producing myocardial infarction model animal
CN103857340A (en) * 2011-10-10 2014-06-11 莫纳什大学 Heart imaging method
US9183763B2 (en) * 2012-01-31 2015-11-10 Vascular Simulations, Llc Cardiac simulation device
JP2015057984A (en) * 2013-09-19 2015-03-30 独立行政法人国立循環器病研究センター Method for preparing ischemic model animal

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