CAJ | 학술논문

目的探讨采用穿刺心尖圈套器固定法辅助完成经导管主动脉瓣置入术的可行性和有效性.方法选择健康实验山羊5只,开腹后分离和穿刺腹主动脉.经穿刺口送加硬导丝至左心室,沿加硬导丝经腹主动脉将带瓣膜支架和支架输送装置送至降主动脉.小切口开胸暴露心尖,直视下穿刺心尖部,J形导丝经左心室-升主动脉送至降主动脉.沿J形导丝送入5F多功能导管和圈套器至降主动脉.操作圈套器,套住并固定支架输送装置头端.前送支架输送装置,将带瓣膜支架送至羊主动脉瓣原位.主动脉瓣上造影确定带瓣膜支架准确到位后,拉紧圈套器以固定支架输送鞘管的头端,防止球囊撑开支架时出现移位.随后撑开球囊,释放支架.术后观察实验效果.结果 5只实验山羊均完成经导管主动脉瓣置入术,术中主动脉瓣上造影显示实验羊的主动脉瓣瓣环直径为(23.8 ±2.6)mm,分别置入直径23 mm带瓣膜支架2枚,直径26 mm带瓣膜支架3枚,手术时间为(112.3±19.5)min,X线透视时间为(16.8±5.2)min,未出现支架移位等并发症.术后即刻人工主动脉瓣上造影和超声心动图检查均显示,带瓣膜支架置入位置理想,人工瓣膜无明显反流及瓣周漏.术后1个月,5只实验山羊均健康存活.结论穿刺心尖圈套器固定法辅助完成经导管主动脉瓣置人术可行,能有效防止支架移位,有助于提高非钙化狭窄性主动脉瓣疾病的手术成功率.
목적 탐토채용천자심첨권투기고정법보조완성경도관주동맥판치입술적가행성화유효성.방법 선택건강실험산양5지,개복후분리화천자복주동맥.경천자구송가경도사지좌심실,연가경도사경복주동맥장대판막지가화지가수송장치송지강주동맥.소절구개흉폭로심첨,직시하천자심첨부,J형도사경좌심실-승주동맥송지강주동맥.연J형도사송입5F다공능도관화권투기지강주동맥.조작권투기,투주병고정지가수송장치두단.전송지가수송장치,장대판막지가송지양주동맥판원위.주동맥판상조영학정대판막지가준학도위후,랍긴권투기이고정지가수송초관적두단,방지구낭탱개지가시출현이위.수후탱개구낭,석방지가.술후관찰실험효과.결과 5지실험산양균완성경도관주동맥판치입술,술중주동맥판상조영현시실험양적주동맥판판배직경위(23.8 ±2.6)mm,분별치입직경23 mm대판막지가2매,직경26 mm대판막지가3매,수술시간위(112.3±19.5)min,X선투시시간위(16.8±5.2)min,미출현지가이위등병발증.술후즉각인공주동맥판상조영화초성심동도검사균현시,대판막지가치입위치이상,인공판막무명현반류급판주루.술후1개월,5지실험산양균건강존활.결론 천자심첨권투기고정법보조완성경도관주동맥판치인술가행,능유효방지지가이위,유조우제고비개화협착성주동맥판질병적수술성공솔.
Objective To evaluate the feasibility and effectiveness of transcatheter aortic valve implantation assisted with snare to fix the delivery system.Methods This study was made in 5 healthy goats.After the abdomen was opened and the abdominal aorta was exposed,a stiff guide wire was advanced into the apex of the left ventricle through abdominal arterial puncture points.The delivery catheter equipped with valved stent was inserted into the descending aorta under fluoroscopy along the stiff guide wire.A minimal thoracic surgery approach was used to access the apex of the heart.A J-type guidewire and 5 F multifunction catheter were placed transapically and across the aortic valve down to the descending aorta.The snare was introduced through the 5 F catheter into the ascending aorta and was controlled to seize the head of stent delivery catheter.Then the delivery catheter was advanced into the left ventricle.The valved stent was positioned in the desired position under aortography and then the balloon was dilated and the valved stent was deployed into the aortic annulus assisted with snare to fix the catheter to prevent stent dispositions.Aortic angiography and echocardiography were performed to evaluate of valve performance post procedure.Results The interventional procedure was completed successfully in all 5 goats.The mean aortic annulus diameter was (23.8 ± 2.6) mm,two valved stent of 23 mm diameter and three valved stent of 26 mm in diameter were implanted.The operation duration and X-ray exposure time were (112.3 ± 19.5) min and (16.8 ± 5.2) min,respectively.Immediate observation after procedure showed that the valved stents were in the desired position after implantation by angiography and echocardiography.No moderate to severe aortic regurgitation was observed.All goats were alive at 1 month post procedure.Conclusions The procedure of transcatheter implantation of a balloon-expandable valved stent into the aortic valve position of goats assisted with snare to fix the delivery catheter is feasible and effective.This procedure might be suitable also for patients with noncalcified aortic stenosis.