CAJ | 학술논문

目的探讨肺动脉自扩张支架瓣膜的制备以及非体外循环下经皮肺动脉瓣膜置入方法.方法将修剪后的牛颈静脉带瓣管道缝制到自扩张镍钛支架上,制成肺动脉自扩张支架瓣膜,并置于人工心脏瓣膜脉动流测试仪中检测通过后备用.借助24F支架输送鞘,经髂外静脉途径置入到8头实验猪的肺动脉瓣位置,行超声心动图和数字减影血管造影(DSA)等检测置入瓣膜功能后解剖.结果肺动脉自扩张支架瓣膜内径(21.9±1.6) mm,外径(24.6±1.5) mm,长(27.9±4.3) mm,有效开瓣面积( 1.83±0.2)cm2.8例中7例置入成功,1例失败.置入后瓣膜两端的峰值跨瓣压差导管法检测为(7.9 ±3.3)mm Hg(1 mm Hg =0.133 kPa),彩色多普勒心脏超声检测为(9.3±4.1)mmHg.心脏DSA显示所有支架瓣膜无移位、反流或瓣周漏.二维心脏超声显示7例瓣膜启闭完全,瓣叶活动良好,彩色多普勒心脏超声测得其中2例轻度反流.心脏解剖证实支架瓣膜位于肺动脉瓣环处,原肺动脉瓣膜被支架挤贴在动脉壁上.结论自扩张肺动脉支架瓣膜能在非体外循环下借助导管经皮置入到肺动脉瓣处,术后短期功能良好,提示自扩张支架瓣膜及经皮肺动脉瓣膜置入术具有可行性和临床应用前景.
목적 탐토폐동맥자확장지가판막적제비이급비체외순배하경피폐동맥판막치입방법.방법 장수전후적우경정맥대판관도봉제도자확장얼태지가상,제성폐동맥자확장지가판막,병치우인공심장판막맥동류측시의중검측통과후비용.차조24F지가수송초,경가외정맥도경치입도8두실험저적폐동맥판위치,행초성심동도화수자감영혈관조영(DSA)등검측치입판막공능후해부.결과 폐동맥자확장지가판막내경(21.9±1.6) mm,외경(24.6±1.5) mm,장(27.9±4.3) mm,유효개판면적( 1.83±0.2)cm2.8례중7례치입성공,1례실패.치입후판막량단적봉치과판압차도관법검측위(7.9 ±3.3)mm Hg(1 mm Hg =0.133 kPa),채색다보륵심장초성검측위(9.3±4.1)mmHg.심장DSA현시소유지가판막무이위、반류혹판주루.이유심장초성현시7례판막계폐완전,판협활동량호,채색다보륵심장초성측득기중2례경도반류.심장해부증실지가판막위우폐동맥판배처,원폐동맥판막피지가제첩재동맥벽상.결론 자확장폐동맥지가판막능재비체외순배하차조도관경피치입도폐동맥판처,술후단기공능량호,제시자확장지가판막급경피폐동맥판막치입술구유가행성화림상응용전경.
Objective The purpose of this study was to investigate the preparation of a pulmonary self-expanding valved stent and the percutaneous implantation of a valved stent in the pulmonary valve position without cardiopulmonary bypass.Methods A bovine jugular valve conduit was trimmed to remove the extraneous materials to reduce profile,and then was sutured onto nitinol stents to form a pulmonary self-expanding valved stent.In vitro,it was tested by a pulsatile mock loop system.Through a 24F delivery system,the valved stents were deployed in the pulmonary valve position of 8 pigs,and then in vivo assessment with echocardiography and a postmortem examination were carried out.Results The pulmonary self-expanding valved stent has an inner diameter of (21.9 ± 1.6) mm,an outer diameter of (24.6 ± 1.5 ) mm,a length of (27.9 ± 4.3 )mm,and an effective orifice area of ( 1.8 ±0.2) cm2.7 of the 8 valved stents were exactly deployed in the native pulmonary valve position,1 valved stent failed.The transvalvular pressure gradient was (7.9 ± 3.3 ) mm Hg by catheter measurement,(9.3 ±4.1 ) mm Hg by Doppler echocardiography.The angiography showed no migration,no regurgitation and no paravalvular leak.The echocartiography showed all the new valves opened and closed well with 2 cases of mild regurgitation.Postmortem examination confirmed the valved stent straddled the pulmonary annuli without migration,the native valve was locked between the stent and arterial wall.Conclusion The acute study demonstrates that the self-expanding valved stent can be successfully implanted in the pulmonary position by a catheter delivery system and function well.Percutaneous pulmonary valve implantation without cardiopulmonary bypass is feasible and has a wide clinical perspective.