TEER Mitral Valve Gyara (V-Clamp)

Kiyasta lokacin karantawa: 10 minti daya

Ma'ana da Tarihi

Gyaran bawul ɗin mitral-zuwa-gefe Wani likitan zuciya ne ya fara kirkiro manufar Ottavio Alfieri by, don gyara prolapse (prolapse) na leaflet na gaba na mitral bawul An gabatar da shi azaman maganin tiyata don wannan. A cikin wannan fasaha, leaflet ɗin da aka zube an dinke shi a takardar da ke gabanta An ƙirƙiri bawul ɗin mitral mai-orifice (biyu-orifice).

Bayan wannan nasarar gyaran aikin tiyata, Gyaran bakin-zuwa-gefen mitral bawul (TEER) dabara da aka ɓullo da. Wannan fasaha, hanya mara cin zarafi ya zama hanyar magani na yau da kullun a cikin marasa lafiya na ɗan adam.

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Amfani a cikin mutane

Hanyar TEER a cikin mutane, Na'urar MitraClip ana yin amfani da shi.

• KYAUTA nazarin yuwuwarWannan shine binciken farko da aka gudanar don kimanta inganci da amincin na'urar MitraClip.

• EVEREST II da COAPT Manyan karatu guda biyu mai suna, ya tabbatar da ingancin TEER a cikin maganin mitral regurgitation mai tsanani (MR) kuma ya haifar da karɓuwa da yawa..

• TEER a cikin mutane ya daina Zaɓin magani mai aminci da inganci don mai tsanani mitral regurgitation ana amfani da shi sosai azaman.

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Ci gaba a Ilimin Zuciya na Dabbobi

Nasarar da aka samu a jikin dan adam ya haifar da samar da irin wannan na'urar a cikin magungunan dabbobi. An tsara wannan na'urar musamman don karnuka. Canine Mitral V-Clamp na'urar.

Canine Mitral V-Clamp Na'urar

• Wannan na'urar, An haɓaka don magance cututtukan mitral valve (DMVD) a cikin karnuka.

• Na farko, A cikin karnuka 1 tare da matakin B8 ya lalata cutar mitral bawul A cikin binciken farko, an nuna amfani da ingancin na'urar.

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Nazarin Clinical

• A cikin karnuka tare da matsananciyar mitral regurgitation (MR) Gwajin yuwuwar na'urar V-Clamp an gane.

Manufar wannan binciken shine don kimanta yadda lafiya da tasiri na na'urar ke cikin karnuka.

• Gyaran bawul ɗin mitral mai jujjuya gefen-zuwa-baki (TEER), Na farko wata hanya da aka samu a cikin mutanekuma Na'urar MitraClip Ana amfani dashi ko'ina don kula da mai tsanani mitral regurgitation (MR) ta amfani da

• A likitan dabbobi, Canine Mitral V-Clamp na'urar, haka nan a cikin karnuka Ciwon mitral bawul (DMVD) an tsara shi don magancewa.

• Karatun farko, amfani da wannan na'urar a cikin karnuka yana nuna cewa yana da amfani kuma mai lafiya.

• Faɗin amfani da ingancin na'urar, Nazarin yiwuwa mai yiwuwa a cikin karnuka tare da mai tsanani mitral regurgitation ana kimantawa da.

Waɗannan abubuwan da suka faru a cikin cututtukan zuciya na dabbobi fitowar sababbin zaɓuɓɓukan da ba za a iya amfani da su ba don maganin cututtukan cututtuka na mitral bawul Yana bayar da.

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Sharuɗɗan cancanta don farawa

Degenerative mitral regurgitation (DMR) karnukan da za a yi wa shiga tsakani saboda Ƙungiyar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru (MR) a cikin mutane dole ne ya cika ka'idojin da aka daidaita.

• Karnuka a cikin ACVIM mataki B2 ko Cana ɗaukar ɗan takara don shiga tsakani.

• Late stage D ko karnuka masu fama da fibrillation (AF), don shiga tsakani ba a la'akari da cancantar 'yan takara.

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Ma'auni na Ganewa don Tsananin Mitral Regurgitation (MR)

Don sanin tsananin MR dole ne a kimanta ma'auni fiye da ɗaya. Sharuɗɗan tallafawa MR mai tsanani Shi ne kamar haka:

• Holosystolic, jets masu kwarara masu launin eccentric suna shafar bango ko fiye da 50% na tsakiyar launi jet rafi rafi

• E-wave rinjaye mitral inflow gudun ≥1.0 m/s

• Tsananin holosystolic triangular regurgitation profile akan ci gaba da igiyar ruwa Doppler

• Regurgitation juzu'i (RF) ≥50% (PISA) ana iya auna shi da girma ko ta Doppler.

• Regurgitation girma (RVol) ≥1.0 ml/kg

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Hanyoyin Kima

• Ƙididdigar Doppler Launi mai gudana:

• A cikin hotuna systolic daban-daban ve dace riba da Nyquist saituna ya kamata a yi la'akari da.

• Yin la'akari da tsananin MR tare da hoto ɗaya na iya kuskuren sa MR ya zama mai tsanani fiye da yadda yake a zahiri.

• Ma'auni na Regurgitation (RF).:

• RF, PISA, Simpson volumetric da/ko hanyoyin Doppler m.

• Aunawa RF tare da hanyoyi da yawa, yana ƙara amincin kimantawa.

• Vena Contracta (VC) Nisa, Regurgitant Volume (RVol) da Ingantacciyar Yankin Orifice Regurgitant (ERO):

Ana iya la'akari da waɗannan ma'auni, amma ya bambanta dangane da girman majiyyaci.

• Har yanzu ba a tantance ainihin ƙimar ƙimar karnuka ba..

• Hagu Ventricle (LV) da Hagu Atrium (LA) Girma:

• Diastolic diastolic na hagu na hagu (LVIDdN)> 1.9 kasancewa

• Hagu atrium/aortic tushen rabo (LA: Ao)> 2.0 kasancewa

• Wadannan canje-canje suna faruwa ne sakamakon MRI canje-canje ne na biyu ve na kullum na cutar ve maganin da aka shafa Yana dogara.

• Fihirisar Ayyukan Systolic:

• Juzu'i na fitarwa na ventricular hagu (LVEF) <50% kasancewa

• Diamita na ƙarshen diastolic na hagu (LVIDsN)> 1.0 kasancewa

Waɗannan sigogi na iya zama alamar cewa yuwuwar rage MR ba ta da ƙarfi.

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Mitral Functional Anatomy da Alakarsa da Nasara

• Mitral bawul aikin jiki, a cikin tsarin TEER yana daya daga cikin mahimman abubuwan da ke tabbatar da nasara da sakamako.

• Girman na'urorin kare da ke akwai An tsara shi a cikin 14 mm, 16 mm da 18 mm.

• Hoton echocardiographic mai shigowa-fitarwa, Diamita na baya-baya (AP) mitral annulus a tsakiyar systole yana tsakanin 14-20 mm Ana ba da shawarar samun.

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Ƙimar Ƙarshe don Gyara-zuwa Gefe

• Ya kamata a kimanta tsarin aikin anatomical na aiki tare da transesophageal echocardiography (TEE) kafin aikin..

• TEE yana nuna karara yana nuna girman, jiki da kuma dacewa da bawul ɗin mitral don aikin.

1. Wadanne karnuka ne suka cancanci TEER?

• Karnuka a cikin ACVIM B2 da C matakan su ne mafi dacewa 'yan takara.

• Dogs a cikin Stage D ve karnuka masu fama da fibrillation (AF)ba 'yan takarar da suka cancanci TEER ba.

2. Ma'auni don Tantance Mummunan MR

• Ana amfani da ma'auni kamar jets masu launin holosystolic, regurgitation juzu'i (RF), faɗin vena contracta da ƙarar regurgitation (RVol).

• Maimakon hoto guda ɗaya, kimantawa ta amfani da hanyoyi da yawa shawarar.

3. Kimanta Tsarin Tsarin Halittu na Aiki

• A cikin karnuka tare da tsarin jikin mutum mai dacewa (jinin kore) rabon nasarar hanya ya fi girma.

• Karnukan tsarin mulki masu dacewa da matsakaici (nau'in rawaya) na iya amfana daga hanyar, amma haɗarin sun fi girma.

• Karnukan da ba su dace da tsarin jikin mutum ba (nau'in ja) Ba 'yan takarar da suka cancanci TEER ba.

4. Binciken Echocardiography na Transesophageal (TEE).

• TEE, shine kayan aiki mafi mahimmanci a cikin kimantawa na ƙarshe da lokacin yanke shawara.

• TEE, yana ba da madaidaicin ƙima na ilimin halittar jiki, girman da tsari na bawul ɗin mitral.

A cikin wannan tsari, daidai zaɓin mara lafiya, aikin jiki tsarin ve pre-procedural kimantawa su ne ainihin abubuwan da ke shafar nasara kai tsaye. Yin kima daidai, yana ƙara yuwuwar hanyar samun nasara da ingancin rayuwar mai haƙuri.

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Gyara-zuwa-Edge Mitral Valve Repair (TEER)

Hanyar TEER a cikin karnuka, maganin sa barci karkashin, mini thoracotomy ve tsarin zuciya na transapical Ana gudanar da kare a wuri mai aminci yayin aikin. a gefen dama na decubitus matsayi (kwance a gefen damansa).

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Maganin tiyata

1. Ƙaddamar da Intercostal Space:

• Mafi kyawun sararin intercostal yawanci 7th intercostal sarari da wannan yanki Hoton fluoroscopic na gefe ve Echocardiography transthoracic (TTE) an tabbatar da amfani.

2. Thoracotomy:

• A 3-4 cm intercostal thoracotomy incision, an yi shi ne kawai dorsal (bangaren sama) na sternum.

3. Bude pericardium:

• An buɗe pericardium kuma sutured zuwa incision hawan koli na zuciya an bayar.

4. Ƙayyadaddun Wurin Sojin Zuciya:

• Hoton Biplane TEE na ventricle na hagu da mitral bawul An ƙayyade wurin huda zuciya ta hanyar matse zuciya ta waje lokacin

• Fitowar shigowa ve a cikin commissural views Ana ɗaukar yanki mai tsayin daka da jirgin mitral bawul a matsayin mafi kyawun huda.

5. Matrix Stitch akan Ramin Zuciya:

• Tare da zaren polypropylene 4-0 biyu alkawarin ƙarfafa matrix dinki, an sanya shi a cikin mafi kyawun wurin huda kuma an ƙarfafa shi tare da tsarin yawon shakatawa.

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Kuskuren kallo da Dubawa

• Hoton Fluoroscopic:

• kusurwar fluoroscopic, yawanci 10° cranial ve 0° zuwa 10° na hagu na gaba an saita kamar .

• Daga hangen mara lafiya, wannan kusurwa 90° zuwa 100°.

• Transesophageal Echocardiography (TEE) Hoto:

• Duban bi-planar a cikin commissural da jiragen da ke fita samu.

• Mitral bawul kuma mai girma uku (3D) en fuska (fuskar gaba) ana kimanta ta da kamanninta.

• Yawancin lokaci ana saita aorta a wurin karfe 9, don haka tabbatar da daidaita motsin na'urar tsakanin TEE da hotunan fluoroscopic.

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Anticoagulation

• Gudanar da Heparin Bolus:

• Kafin shiga cikin zuciya, ta hanyar jijiya 50 U/kg An ba.

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V-Clamp Aunawa da Wuri

Girman V-Clamp:

• 14mm, 16mm da 18mm Akwai nau'ikan V-Clamp guda uku akwai.

Girman V-Clamp, Diamita na bawul na gaba-baya (AP) a tsakiyar systole akan kallon TEE mai shigowakuma an ƙaddara wannan ƙimar bisa ga An cire 1-2 mm.

Bude Ramin Zuciya da Shirye-shiryen Hanyar Shiga:

• Catheter mai allura 18G zuciya ta soki.

• 0.035" 50 cm J-tip guidewire, an wuce ta cikin catheter kuma a aika zuwa ventricle na hagu.

• An cire catheter kuma a kan wayar jagora Mai gabatarwa na 14F yana haɓaka cikin ventricle na hagu..

Wurin Mitral Valve:

• J-tipped waya da dilator, tare da jagorar hanyar wucewa ta musamman tare da titin kwandon nitinol mai laushi an canza.

• Jagora, tare da taimakon TEE wuce retrogradely ta mitral bawul kuma kullin shiga yana ci gaba zuwa cikin atrium na hagu.

Wurin Matsa V-Clamp:

• Na'urar rarraba V-ClampAna isar da shi zuwa atrium na hagu ta hanyar kumfa mai shiga.

• Amfani da makamai na V-Clamp, TEE da fluoroscopy tsaka-tsaki-tsaki, gaba-baya (AP) da juyawa an saita a daidaitawa.

Ɗaukar Leaflet Mitral Valve:

• Ƙananan makamai, an wuce ta cikin mitral bawul kuma an sanya shi a ƙarƙashin takaddun.

• Sannan, Hannu na sama suna saukar da su don kama takardun kuma an rufe V-Clamp.

• Ana kama takardu, Tabbatar da TEE da fluoroscopy sai me Makullan V-Clamp.

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Sarrafa da kimantawa

• Tabbatar da Ɗaukar Leaflet:

• An auna sassan bangon baya (kyauta) na gaba da na baya kuma tsayin ɗan littafin da ya fi 4 mm an tabbatar da shi kamar yadda ya cancanta.

• Tsawon leaft, cire daga tsayin da aka auna a baya an tabbatar da kama daidai.

• Amfani da V-Clamp na biyu:

• A wasu lokuta, Ana iya amfani da V-Clamp na biyu don gyara sauran MR.

• Na biyu V-Clamp, sanya kusa da na'urar matsewa ta farko kuma ana bin wannan hanya.

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Hanyar TEER a cikin karnuka don magance degenerative mitral regurgitation (DMR) amfani da zamani, mara amfani dabara ce. Wannan tsari:

• Mini thoracotomy ve tsarin zuciya na transapical ana yi da.

• TEE da fluoroscopy an umurce shi da.

• Daidaitaccen wuri na na'urar V-Clamp da nasarar kama takardunyana ƙayyade nasarar aikin.

• V-Clamp na biyu, ana iya amfani dashi don ƙarin gyarawa.

• Anticoagulation tare da heparin, yana hana samuwar jini yayin aikin.

Wannan tsari tsawaita rayuwar karnuka tare da cututtukan mitral bawul na degenerative ve inganta ingancin rayuwa yana da babban damar.

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Wasu Labarun Kuna iya Sha'awarsu

• Maganin Stenosis na Pulmonary
• Tsarin Jarrabawar Zuciyar ku
• Rufe Patent Ductus Arteriosus (PDA)
• Transesophageal Echocardiography (TEE)
• Myxomatous Mitral Valve Disease (MMVD)

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"Mutum mai al'ada shine wanda bai gamsu da kansa kawai ba."

Andre Gide

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