CAJ | 학술논문

目的探讨自膨式带瓣膜主动脉瓣支架(瓣膜支架)行体外原位主动脉瓣置换后对冠状动脉的影响.方法采用12只离体小香猪的升主动脉,经冠脉流量测试系统测得基础的左右冠脉流量(基础流量)、瓣膜支架植入后的冠脉流量(保留瓣膜组)及去除正常瓣膜后再次植入支架的左右冠脉流量(去除瓣膜组),并结合内窥镜检查及解剖观察支架及冠脉开口的情况.结果保留瓣膜组左冠流量较基础流量明显较少(29.46%, P<0.05),右冠流量虽有所减少,但差异无统计学意义(P>0.05).去除瓣膜组左右冠脉流量较基础流量有所减少(左冠6.82%,右冠5.37%),但差异均无统计学意义(P>0.05),左冠流量较保留瓣膜时明显改善(32.09%,P<0.05).解剖发现左冠开口相对较低.内窥镜检查发现,在保留瓣膜组正常主动脉瓣瓣叶被支架压向侧壁,造成左冠开口完全阻塞3只,部分阻塞4只,右冠开口部分阻塞3只.两组中共见5只瓣膜支架的瓣脚影响冠脉开口,使其部分阻塞,其中左冠4只,右冠1只.结论该自膨式瓣膜支架行原位主动脉瓣植入后,被压向侧壁的瓣叶易使左冠开口阻塞.同时瓣膜支架的瓣脚有时也会部分影响冠脉流量.
목적 탐토자팽식대판막주동맥판지가(판막지가)행체외원위주동맥판치환후대관상동맥적영향.방법 채용12지리체소향저적승주동맥,경관맥류량측시계통측득기출적좌우관맥류량(기출류량)、판막지가식입후적관맥류량(보류판막조)급거제정상판막후재차식입지가적좌우관맥류량(거제판막조),병결합내규경검사급해부관찰지가급관맥개구적정황.결과 보류판막조좌관류량교기출류량명현교소(29.46%, P<0.05),우관류량수유소감소,단차이무통계학의의(P>0.05).거제판막조좌우관맥류량교기출류량유소감소(좌관6.82%,우관5.37%),단차이균무통계학의의(P>0.05),좌관류량교보류판막시명현개선(32.09%,P<0.05).해부발현좌관개구상대교저.내규경검사발현,재보류판막조정상주동맥판판협피지가압향측벽,조성좌관개구완전조새3지,부분조새4지,우관개구부분조새3지.량조중공견5지판막지가적판각영향관맥개구,사기부분조새,기중좌관4지,우관1지.결론 해자팽식판막지가행원위주동맥판식입후,피압향측벽적판협역사좌관개구조새.동시판막지가적판각유시야회부분영향관맥류량.
Objective To study the effects of self-expandable and orthotopically implanted percutaneous aortic valved stent on coronary artery flow in vitro. Methods Self-expandable valved stent was developed with nitinol stent and bovine pericardium. The ascending aorta of Chinese miniswine hearts was cut proximal to the brachiocephalic trunk. The right and left main coronary arteries were dissected. In vitro coronary flow tests were performed. Firstly, baseline coronary flow with the native aortic valve was measured (n=12). Secondly, the valved stent was deployed orthotopically. The commissures of prosthesis were positioned randomly. Through an endoscope, the effects of valved stent and native valve on coronary ostium were obtained and coronary flow measurements repeated (valve preservation group, n=12). Then the distance from coronary ostium to native leaflet free edge was measured. Native leaflets were removed before similar valved stent deployment. Coronary flow measurements and endoscopic inspections were repeated post-implantation (valve removal group, n=12).Results In valve preservation group, valved stent implantation resulted in a significant decrease in left coronary flow (29.46%, P<0.05). The obstruction was due to native leaflets sandwiched between the stent and aortic wall. The left ostia were obstructed totally in 3 and partially in 4. The flow of right coronary decreased 7.34% (P>0.05). The right ostia were obstructed partialy in 3. In valve removal group, 6.82% and 5.37% decrement in left and right coronary flow were observed after valved stent placement (P>0.05). The distances from right coronary ostia to annulus were farther than from left coronary ostia. In two groups, the commissures of prosthesis obstructed partially left coronary ostia in 4 and right coronary ostia in 1.Conclusion Orthotopic implantation of a percutaneous self-expandable aortic valved stent would obstruct the left coronary ostium with the native valve. Coronary ostium may be obstructed partly by the commissures of prosthesis.