中华实验外科杂志
中華實驗外科雜誌
중화실험외과잡지
CHINESE JOURNAL OF EXPERIMENTAL SURGERY
2015年
8期
1840-1843
,共4页
导管%二尖瓣成形术%经心尖%环中瓣
導管%二尖瓣成形術%經心尖%環中瓣
도관%이첨판성형술%경심첨%배중판
Transcatheter%Mitral valve%Transapical%Valve-in-ring
目的 验证无体外循环支持下心尖径路成形环内二尖瓣支架植入的可能性,评价自制自扩张支架瓣膜功能.方法 7头成年猪,体质量(58.3±5.55) kg,体外循环下植入26 mm二尖瓣成形环,撤除体外循环,导管下经心尖植入30 mm自制二尖瓣带瓣膜自扩张支架,评价血流动力学及瓣膜功能.结果 非体外循环导管下经心尖成形环内二尖瓣支架植入成功率为100％,植入时间为(21.6±5.3) min,整个过程血流动力学平稳,植入前后各项指标差异无统计学意义(P＞0.05).植入的自扩张瓣膜支架平均瓣环直径、瓣膜功能面积和跨瓣压差分别为(2.58±0.03) cm、(4.22±0.44) cm2和(4.6 ±4.7)mmHg(1 mmHg =0.133 kPa).心内超声下探及微量或少量返流.术后大体标本检查支架均良好地固定在成形环上.结论 非体外循环导管下经心尖成形环内植入二尖瓣支架瓣膜是可行、安全的.对于一些成形后二尖瓣返流复发的高危患者,进行导管下成形环内二尖瓣置换,心尖径路或许是一个理想的路径.自制的自扩张支架瓣膜有着接近于正常瓣膜的功能面积.
目的 驗證無體外循環支持下心尖徑路成形環內二尖瓣支架植入的可能性,評價自製自擴張支架瓣膜功能.方法 7頭成年豬,體質量(58.3±5.55) kg,體外循環下植入26 mm二尖瓣成形環,撤除體外循環,導管下經心尖植入30 mm自製二尖瓣帶瓣膜自擴張支架,評價血流動力學及瓣膜功能.結果 非體外循環導管下經心尖成形環內二尖瓣支架植入成功率為100％,植入時間為(21.6±5.3) min,整箇過程血流動力學平穩,植入前後各項指標差異無統計學意義(P＞0.05).植入的自擴張瓣膜支架平均瓣環直徑、瓣膜功能麵積和跨瓣壓差分彆為(2.58±0.03) cm、(4.22±0.44) cm2和(4.6 ±4.7)mmHg(1 mmHg =0.133 kPa).心內超聲下探及微量或少量返流.術後大體標本檢查支架均良好地固定在成形環上.結論 非體外循環導管下經心尖成形環內植入二尖瓣支架瓣膜是可行、安全的.對于一些成形後二尖瓣返流複髮的高危患者,進行導管下成形環內二尖瓣置換,心尖徑路或許是一箇理想的路徑.自製的自擴張支架瓣膜有著接近于正常瓣膜的功能麵積.
목적 험증무체외순배지지하심첨경로성형배내이첨판지가식입적가능성,평개자제자확장지가판막공능.방법 7두성년저,체질량(58.3±5.55) kg,체외순배하식입26 mm이첨판성형배,철제체외순배,도관하경심첨식입30 mm자제이첨판대판막자확장지가,평개혈류동역학급판막공능.결과 비체외순배도관하경심첨성형배내이첨판지가식입성공솔위100％,식입시간위(21.6±5.3) min,정개과정혈류동역학평은,식입전후각항지표차이무통계학의의(P＞0.05).식입적자확장판막지가평균판배직경、판막공능면적화과판압차분별위(2.58±0.03) cm、(4.22±0.44) cm2화(4.6 ±4.7)mmHg(1 mmHg =0.133 kPa).심내초성하탐급미량혹소량반류.술후대체표본검사지가균량호지고정재성형배상.결론 비체외순배도관하경심첨성형배내식입이첨판지가판막시가행、안전적.대우일사성형후이첨판반류복발적고위환자,진행도관하성형배내이첨판치환,심첨경로혹허시일개이상적로경.자제적자확장지가판막유착접근우정상판막적공능면적.
Objective To evaluate the feasibility of off-pump transapical mitral valve-in-ring implantation and to test the performance of a custom-made self-expandable stent valve.Methods Seven pigs,mean weight (58.3 ± 5.5) kg,underwent mitral valve annuloplasties under cardiopulmonary bypass using 26 mm rings (SJMTM).Then,a 30 mm custom-made self-expandable stent valve was deployed within the annuloplasty rings through a transapical access under fluoroscopic guidance and off pump.Results 100％ (7 of 7) success was in the procedural of transapical mitral valve-in-ring implantation.Mean transapicai procedure time was (21.6 ±5.3) min.Haemodynamic status during transapical implantation remained stable,and differences in data collected before and after the stent-valve deployment were not statistically significant.Mean mitral annulus diameter and mean mitral orifice area were (2.58 ± 0.03) cm and (4.22 ±0.44) cm2.Trace or mild regurgitation was detected.Mean gradients were (4.6 ± 4.7) mmHg (1 mmHg =0.133 kPa) across the self-expandable stent valves.Postmortem examination confirmed adequate positioning of the self-expandable valves within the annuloplasty ring.Conclusion Transapical mitral valve-in-ring implantation without cardiopulmonary bypass is safe and feasible.Transapical access may represent the ideal option for valve-in-ring procedures in cases of recurrent mitral regurgitation after mitral valve repair,in high-risk patients.Owing to the supra-annular profile of the valve components,our custom-made nitinol stent valve provides nearer to normal functional area.
