主动脉瓣发展ppt培训课件

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1、PracticalandEngineeringConsiderationsinCatheter-basedAorticValveDevelopmentRobertF.Wilson,M.D.UniversityofMinnesotaPercutaneousValveDesignRequirementsDeliverabilityDeliveringthevalvetothevalveorificeDeployabilityAccuratelydeployingthevalveinthevalveorificeStickabilityDesigningthevalve

2、toadheretothevalveorificeFunctionalityValvefunctionsasaone-wayvalvefortheorificeDurabilityValveretainsfunctionandpositionforthedesiredlifetimeDeliverySize(!)DeliverysystemdiameterdeterminesdeliveryoptionsNormaladulthumanvasculardimensions:Femoralarteryaverages4.5-7.6mmindiameter(14-24

3、Fr)Femoralveinaverages10mmindiameter(31F)5-7%ofpatientswitha9.5FrIABPdeveloplimbischemiaOLIVEetal:Med.Sci.SportsExerc.,35:901-907,2003.Ohmanetal:Circulation.90(2):792-9,1994Pfiefferetal:JCardiovascSurg2005;46:55Packingsize:“putting5gmina2gmbag”A21mmcuffhasacircumferenceof66mmA19mmval

4、vediameterasacircumferenceof60mm21mm66mm19mm60mm6.4mm20mm+20F4.7mm15mm15FAvailableInternalCSABasedonGuideCatheterOuterDiameterDeliverycatheterinternalCSA(assumingwallthickness=0.28mm)10F6.6012F9.7314F13.5916F18.0918F23.2420F29.0322F35.4324F42.31CSA=cross-sectionalareaiCSA(mm2)05101520

5、25303540458101214161820222426FrAvailablevalvematerialStentthicknessesrangefrom:0.002to0.010”Pericardialthicknessesrangefrom:Bovine0.012-0.014”Porcine0.007-0.008”Equine0.006-0.007”SIS0.002-0.003”PackedCSAforValveTissueValvethickness(mm)PackedCSA(mm2)0.0503.00.0754.40.1005.90.1257.40.15

6、08.90.17510.30.20011.80.22513.30.27516.20.30017.6PorcinepericardiumBovinepericardiumEquinepericardiumSISPackedCSAforValveCufforStentCuffthickness(mm)PackedCSA(mm2)0.0503.30.0754.90.1006.60.1258.20.1509.80.17511.40.20013.10.22514.70.27517.90.30019.5NitinolStainlesssteel+balloonCSAPacke

7、dvalveCSAv.DeliveryCatheterCSA0510152025303540458101214161820222426DeliveryCatheterSize(Fr)ValveCSA(packed)CuffCSA(packed)CSA(mm2)BigDeliveryCatheters=BigProblemsManypercutaneousaorticvalvesunderdevelopmentrequiredeliverycatheters>20Fr.Thisnecessitates:atransvenous-trans-septalapproac

8、horah