开胸穿刺心尖行经导管主动脉瓣置入术的实验研究.pdf

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1、中华心血管病杂志2014年1月第42卷第1期ChinJCardiol，January2014，Vo1．42No．1·31·．介入治疗．开胸穿刺心尖行经导管主动脉瓣置人术的实验研究陈翔马丽萍谭洪文张志钢朱玉峰张本李铭辉王倩白元吴弘王韦刘盈盈赵仙先秦永文【摘要】目的探讨采用带瓣膜球囊扩张支架经心尖途径行经导管主动脉瓣置入术的可行性和有效性。方法自主设计圆柱状网状钴铬合金支架，将新鲜的牛心包经脱细胞、防钙化等处理后裁剪成人工瓣膜，缝合在钴铬合金支架上，制成带瓣膜主动脉瓣支架。选择健康羊5只，小切口开胸暴露心尖，穿刺左心室心尖，建立轨道。在x线引导下，沿加硬导丝经22F输送鞘管将带瓣

2、膜支架送至主动脉瓣位置，并扩张球囊释放支架。手术后即刻观察实验效果。结果1只实验羊因支架置入位置过低突入左心室，造成主动脉瓣大量反流而死亡，其余4只实验羊均成功置入带瓣膜球囊扩张支架。术后即刻数字减影血管造影、超声心动图及解剖结果显示，带瓣膜支架置人位置理想，人工瓣膜代替原瓣膜工作，其中3例有微量至轻度的瓣周漏，无明显反流。结论使用新型国产带瓣膜球囊扩张支架及输送装置经心尖途径行经导管主动脉瓣置入术可行、有效。【关键词】主动脉瓣；支架；治疗结果Anexperimentstudyoftranscathetertransapicalaorticvalveimplantationw

3、ithanewdomesticballoon-expandablebioprostheticaorticvalveingoatsCheaXiang，MaLiping，TanHongwen，ZhangZhigang，ZhuYufeng，ZhangBen，LiMinghui，WangQian，BaiYuan，WuHong，Wang，LiuYinging，ZhaoXianxian，QiaYongwen．DepartmentofCardiology，ChanghaiHospital，SecondMilitaryMedicalUniversity，Shanghai200433，Chin

4、aCorrespondingauthor：QinYongwen，Email：qyw20070901@sina．com【Abstract】ObjectiveToevaluatethefeasibilityandeffectivenessoftranscathetertransapicalimplantationofanewdomesticballoon—expandablebioprostheticaorticvalveingoats．MethodsWedevelopedanewtube—likeballoon—expandablebioprosthcticaorticvalv

5、ewhichwasmadefromcobah—chromiumalloyandbovinepericardium．Briefly．freshbovinepericardiumwastrimmedintoartificialleafletsandsuturedintothecobalt—chromiumalloystentbyhandpostcellextractingandanti—calciflcationtreatments．Aleftanterolateralminithoracotomywasperformedinthe5intercostalspaceof5goat

6、s．Afteropeningthepericardium，theapexoftheleftventriclewaspunctured，astifguidewirewaspositionedacrosstheaorticarchandanchoredinthedescendingaorta．Thedeliverycatheter(22F)wasthenintroducedthroughthestifguidewireintotheaortaarchunderfluoroscopicguidance．Aftercorrectvalvepositionwasconfirmedbyd

7、igitalsubtrationangiography，thevalvedstentwasimplantedafterrapidinflationoftheballoon．Theimmediateresultsofimplantedvalvedstentswereevaluatedwithangiographyandechocardiography．ResultsFourdevicesweresuccessfullyimplantedintoaorticvalvepositionofgoatsandon