摘要
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入术可行,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.
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.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2014年第10期873-877,共5页
Chinese Journal of Cardiology
基金
中国博士后科学基金（2014M551330）
上海市重点科技攻关项目（10441902100）
关键词
主动脉瓣
支架
可行性研究
Aortic valve
Stents
Feasibility studies
