Hoʻoponopono ʻo TEER Mitral Valve (V-Clamp)

Manaʻo manawa heluhelu: 10 minuke

Wehewehe a me ka mōʻaukala

Hoʻoponopono ʻaoʻao i ka ʻaoʻao mitral valve Ua hoʻomohala mua ʻia ka manaʻo e ke kauka lapaʻau cardiac Ottavio Alfieri na, e hoʻoponopono i ka prolapse (prolapse) o ka lau mua o ka valve mitral Ua manaʻo ʻia ma ke ʻano he hopena ʻokiʻoki no kēia. Ma kēia ʻenehana, humuhumu ʻia ka lau i hoʻopaʻa ʻia i ka lau e kū pono ana Hoʻokumu ʻia kahi lua-orifice (double-orifice) mitral valve.

Ma hope o kēia kaʻina hana hoʻoponopono ʻokiʻoki kūleʻa, ʻO ka hoʻoponopono hou ʻana o ka valve mitral transcatheter edge-to-edge (TEER) ua hoʻomohala ʻia ka ʻenehana. ʻO kēia ʻenehana, he ala komo ole ua lilo i mea lapaʻau maʻamau i nā maʻi kanaka.

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Hoʻohana i ke kanaka

ʻO ke kaʻina hana TEER i nā kānaka, Mea hana MitraClip ua pau ka hoohana ana.

• EVEREST haʻawina kūponoʻO kēia ka haʻawina mua i hana ʻia e loiloi i ka pono a me ka palekana o ka mea MitraClip.

• EVEREST II a me COAPT ʻElua mau haʻawina nui i kapa ʻia, ua hōʻoia i ka maikaʻi o TEER i ka mālama ʻana i ka mitral regurgitation koʻikoʻi (MR) a ua alakaʻi i kona ʻae ākea.

• ʻAʻole ʻo TEER i loko o ke kanaka ʻO kahi koho lapaʻau palekana a maikaʻi no ka regurgitation mitral koʻikoʻi hoʻohana nui ʻia e like me.

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ʻO nā holomua i ka Cardiology Veterinary

ʻO ka holomua i loaʻa i loko o ke kanaka alakaʻi i ka hoʻomohala ʻana i kahi mea like i ka lāʻau lapaʻau holoholona. Ua hoʻolālā ʻia kēia mea hana no nā ʻīlio. Canine Mitral V-Clamp mea hana.

Mea Hana V-Clamp Canine Mitral

• keia mea hana, Hoʻomohala ʻia e mālama i ka maʻi degenerated mitral valve (DMVD) i nā ʻīlio.

• ʻO ka mea mua, I nā ʻīlio 1 me ka pae B8 degenerated mitral valve maʻi Ma kahi haʻawina mua, ua hōʻike ʻia ka hoʻohana ʻana a me ka pono o ka hāmeʻa.

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Haʻawina Haumana

• I nā ʻīlio me ka mitral regurgitation koʻikoʻi (MR) ʻO ka hoʻāʻo kūpono o ka mea V-Clamp ua hoʻokō ʻia.

• ʻO ke kumu o kēia haʻawina ʻo ia ka loiloi i ka palekana a me ka maikaʻi o ka mea hana i nā ʻīlio.

• ʻO ka hoʻoponopono ʻana i ka valve mitral lihi-a-kaʻe Transcatheter (TEER), Ka mua he kaʻina hana i kūkulu ʻia i loko o ke kanakaa Mea hana MitraClip Hoʻohana nui ia e mālama i ka mitral regurgitation (MR) me ka hoʻohana ʻana

• I ka lāʻau lapaʻau holoholona, Canine Mitral V-Clamp mea, pela no na ilio degenerated mitral valve maʻi (DMVD) ua hoʻolālā ʻia e mālama.

• Haʻawina mua, ka hoʻohana ʻana i kēia mea hana i nā ʻīlio hōʻike ʻia he kūpono a palekana.

• ʻoi aku ka maikaʻi o ka hoʻohana ʻana a me ka maikaʻi o ka hāmeʻa, ʻO ke aʻo ʻana kūpono i nā ʻīlio me ka mitral regurgitation koʻikoʻi loiloi ʻia me.

ʻO kēia mau hanana i ka cardiology veterinary ka puka ʻana mai o nā koho hou, non-invasive no ka mālama ʻana i ka maʻi degenerated mitral valve Ua 'oi aku.

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Nā Paʻi Pono no ka Hoʻomaka

Degenerative mitral regurgitation (DMR) nā ʻīlio e hoʻopili ʻia ma muli o ʻO ka American Society of Echocardiography (ASE) koʻikoʻi no ka mitral regurgitation koʻikoʻi (MR) i nā kānaka pono e hoʻokō i nā pae hoʻohālikelike.

• Nā ʻīlio ma ka pae ACVIM B2 a i ʻole Cua manaʻo ʻia he moho no ka hana mitral.

• ʻO ka pae hope D ai ole ia, nā ʻīlio me ka atrial fibrillation (AF), no ka hana mitral ʻaʻole i manaʻo ʻia he mau moho kūpono.

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Nā Koina Hoʻomaʻamaʻa ʻana no ka Severe Mitral Regurgitation (MR)

E hoʻoholo i ka paʻakikī o MR pono e loiloi ʻia ma mua o hoʻokahi pae. Nā mea e kākoʻo ana i ka MR koʻikoʻi He like penei:

• Holosystolic, eccentric kala kahe kahe e pili ana i ka paia ai ole ia, ʻoi aku ka nui ma mua o 50% o ka wahi jet kahawai kala waena

• ʻO ka wikiwiki o ke kahe ʻana o ka mitral ʻo E-1.0 m/s

• ʻO ka ʻike holosystolic triangular regurgitation koʻikoʻi ma ka Doppler nalu mau

• ʻO ka hakina hoʻihoʻi hou (RF) ≥50% (PISA) Hiki ke ana volumetrically a i ole Doppler paha.

• Ka nui o ka regurgitation (RVol) ≥1.0 mL / kg

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Nā ʻano loiloi

• Ka Loiloi Doppler Waiwai:

• Ma nā kiʻi systolic likeʻole ve loaʻa kūpono a me nā hoʻonohonoho Nyquist pono e loiloi me.

• ʻO ka loiloi ʻana i ke koʻikoʻi o ka MR me ke kiʻi hoʻokahi e hōʻike hewa paha i ka MR ma mua o kona ʻano maoli.

• Ana ʻana i ka hakina hoʻihoʻi hou (RF).:

• RF, PISA, Simpson volumetric a / a i ʻole nā ​​ala Doppler hiki ke ana.

• Ke ana ʻana i ka RF me nā ʻano hana he nui, hoʻonui i ka hilinaʻi o ka loiloi.

• ʻO Vena Contracta (VC) Laulā, Volume Regurgitant (RVol) a me kahi ʻāpana Orifice Regurgitant Pono (ERO):

• Hiki ke laweia keia mau ana, aka ʻokoʻa ma muli o ka nui o ka mea maʻi.

• ʻAʻole i hoʻoholo piha ʻia nā kumukūʻai palena kūpono no nā ʻīlio..

• Hoʻonui ʻia ka Ventricle hema (LV) a me ka Atrium hema (LA).:

• Left ventricular diastolic internal diameter (LVIDdN) >1.9 e

• Lakiō atrium hema/aʻa aʻa (LA:Ao) >2.0 e

• Loaʻa kēia mau hoʻololi ma muli o ka MRI he mau hoʻololi lua ve ka ma'i mau ve ka lapaau ana Ua hilinaʻi nui.

• Nā Hōʻike Hana Systolic:

• ʻO ka hakina hoʻokuʻu ʻana i ka ventricular hema (LVEF) <50% e

• ʻO ke anawaena hope-diastolic ventricular hema (LVIDsN) >1.0 e

• He hōʻailona paha kēia mau ʻāpana i ka nāwaliwali o ka hiki ke hōʻemi i ka MR.

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Mitral Functional Anatomy a me kona pilina me ka holomua

• Puka mitral anatomy hana, ma ke kaʻina hana TEER ʻo ia kekahi o nā mea nui e hoʻoholo ai i ka holomua a me nā hopena.

• Nā ana o nā mea ʻīlio i loaʻa Hoʻolālā ʻia ma 14 mm, 16 mm a me 18 mm.

• Apical inflow-outflow kiʻi echocardiographic, Aia ke anawaena annulus mitral anterior-posterior (AP) ma waena o ka systole ma waena o 14-20 mm. Paipai ʻia e loaʻa.

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Hoʻoholo hope no ka hoʻoponopono ʻana i ka Edge-to-Edge

• Pono e loiloi ʻia ke ʻano anatomical hana me ka transesophageal echocardiography (TEE) ma mua o ke kaʻina hana..

• Hōʻike maopopo loa ʻo TEE i ka nui, anatomy a me ke kūpono o ka valve mitral no ke kaʻina hana.

1. ʻO wai nā ʻīlio i kūpono no TEER?

• Nā ʻīlio ma ka pae ACVIM B2 a me C nā moho kūpono loa.

• Nā ʻīlio i ka pae D ve nā ʻīlio me ka atrial fibrillation (AF)ʻaʻole lākou he mau moho no TEER.

2. Nā Paʻa no ka loiloi ʻana i ke koʻikoʻi o MR

• Hoʻohana ʻia nā mea pono e like me ka holosystolic colored flow jets, regurgitation fraction (RF), vena contracta width a me regurgitation volume (RVol).

• Ma kahi o ke kiʻi hoʻokahi, loiloi me ka hoʻohana ʻana i nā ʻano hana he nui paipai ʻia.

3. Ka Loiloi o ka Hana Anatomical Structure

• I nā ʻīlio me ke ʻano anatomical kūpono (ka māhele ʻōmaʻomaʻo) ʻoi aku ka kiʻekiʻe o ke kaʻina hana.

• Nā ʻīlio o ke kumukānāwai kūpono kūpono (māhele melemele) hiki ke pōmaikaʻi mai ke kaʻina hana, akā ʻoi aku ka nui o nā pilikia.

• Nā ʻīlio me ke ʻano anatomical kūpono ʻole (ka ʻāpana ʻulaʻula) ʻAʻole lākou he mau moho no TEER.

4. ʻO ka loiloi Transesophageal Echocardiography (TEE).

• TEE, ʻo ia ka mea hana koʻikoʻi i ka loiloi hope a me ka hana hoʻoholo.

• TEE, hāʻawi i ka loiloi pololei o ka morphology, ka nui a me ke ʻano o ka valve mitral.

Ma keia hana, koho pono ma'i, hana anatomical structure ve loiloi mua kaʻina hana ʻo ia nā mea kumu e pili pono ana i ka holomua. Hana i ka loiloi kūpono, hoʻonui i ka likelihood o ke kaʻina hana e holomua a me ka maikaʻi o ke ola o ka mea maʻi.

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Hoʻoponopono ʻo Transcatheter Edge-to-Edge Mitral Valve (TEER)

ʻO ke kaʻina hana TEER i nā ʻīlio, anesthesia maʻamau lalo, mini thoracotomy ve hoʻokokoke naʻau transapical Mālama ʻia ka ʻīlio ma kahi palekana i ka wā o ke kaʻina hana. ma ke kulana decubitus aoao akau (e moe ana ma kona aoao akau).

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Hoʻopiʻi ʻokiʻoki

1. ʻO ka hoʻoholo ʻana o ka Intercostal Space:

• 'O ka mea ma'amau ka wahi intercostal maika'i loa 7th intercostal space a me keia wahi kiʻi fluoroscopic ʻaoʻao ve transthoracic echocardiography (TTE) hōʻoia ʻia me ka hoʻohana ʻana i .

2. Thoracotomy:

• He 3-4 knm intercostal thoracotomy incision, hana ʻia i hope wale nō (ma luna) o ka sternum.

3. E wehe ana i ka Pericardium:

• Wehe ʻia ka pericardium a humuhumu ia i ka oki kiʻekiʻe o ka puʻuwai puʻuwai hāʻawi ʻia.

4. Ka Hoʻoholo ʻana i ka Lae ʻImi Puʻuwai:

• ʻO ke kiʻi Biplane TEE o ka ventricle hema a me ka valve mitral Hoʻoholo ʻia ka pae o ka puʻuwai puʻuwai e ka hoʻoemi waho o ka puʻuwai i ka wā

• Komo-waho ve ma na manao commissural ʻO kahi ʻāpana e kū pono ana i ka mokulele valve mitral i manaʻo ʻia ʻo ia ka wahi puncture maikaʻi loa.

5. Ku'i Matrix ma ka Pu'uwai:

• Me ke kaula polypropylene 4-0 mau humuhumu matrix i hoʻoikaika ʻia, Hoʻokomo ʻia i loko o ka pūnaewele puncture maikaʻi loa a hoʻopaʻa ʻia me ka ʻōnaehana tourniquet.

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Nānā a nānā i nā kihi

• Kiʻi Fluoroscopic:

• Fluoroscopic angle, maʻamau 10° cranial ve 0° a 10° hema oblique mua ua hoonohoia e like me .

• Mai ka manaʻo o ka mea maʻi, kēia kihi 90° a 100°.

• ʻO ke kiʻi kiʻi Transesophageal Echocardiography (TEE).:

• Nānā Bi-planar ma nā mokulele commissural a inflow-outflow loaa.

• Mitral valve pū kekahi ʻekolu-dimensional (3D) en alo ( alo alo) loiloi ʻia e kona helehelena.

• Hoʻonohonoho pinepine ʻia ka aorta ma ke kūlana 9 o'clock, no laila e hōʻoia i ka neʻe ʻana o ka mea hana ma waena o TEE a me nā kiʻi fluoroscopic.

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ʻO ka hoʻopaʻa ʻana

• Heparin Bolus Administration:

• Ma mua o ke komo ʻana i ka puʻuwai, intravenously 50 U/kg heparin Ua pono i haawiia mai.

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V-Clamp Ana a me ka Hookomo

Nā ʻāpana V-Clamp:

• 14mm, 16mm a me 18mm Aia ʻekolu mau nui V-Clamp i loaʻa.

• ka nui V-Clamp, Ma mua-hope (AP) mitral valve anawaena ma ka waena-systole ma ka inflow-outflow TEE nanaa ua hoʻoholo ʻia kēia waiwai e like me Wehe ʻia ka 1-2 mm.

Wehe i ka Puʻuwai a me ka hoʻomākaukau ʻana i ke ala komo:

• He catheter me kahi nila 18 G ua houia ka naau.

• 0.035” 50 knm J-tip uea alakaʻi, hele ʻia ma ka catheter a hoʻouna ʻia i ka ventricle hema.

• Wehe ʻia ka catheter a ma ka uwea alakai Hoʻokomo ʻia ka mea hoʻolauna 14F i ka ventricle hema..

ʻO ke ala ʻo Mitral Valve:

• Uea a me ka dilator J-tipped, me kahi alakaʻi ala mitral kūikawā me ka piko hina hina nitinol ua hoololiia.

• alakaʻi, me ke kōkua o TEE ua hala hope ma o ka pahu mitral a hoʻokomo ʻia ka puʻu komo i ka atrium hema.

Hoʻokomo V-Clamp:

• ʻO nā mea hoʻohele V-ClampHāʻawi ʻia i ka atrium hema ma o ka puʻu komo.

• Hoʻohana i nā lima V-Clamp, TEE a me ka fluoroscopy medial-lateral, anterior-posterior (AP) a me ka rotational ua hoʻonohonoho ʻia ma ka hoʻonohonoho.

ʻO ka hoʻopaʻa ʻia ʻana o ka lau ʻo Mitral Valve:

• Nā lima haʻahaʻa, hele ʻia ma ka pahu mitral a waiho ʻia ma lalo o nā lau.

• A laila, hoʻokuʻu ʻia nā lima o luna e hopu i nā lau a ua paa ka V-Clamp.

• Loaʻa nā lau, Ua hōʻoia ʻia e TEE a me ka fluoroscopy a laila Nā laka V-Clamp.

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Ka Mana a me ka Loiloi

• Hōʻoia Hoʻopaʻa Paʻa Pepa:

• Ua ana 'ia ka 'āpana 'ole (free) o ka lau mua a me hope ʻOi aku ka lōʻihi ma mua o 4 mm ua hooiaioia e like me ka pono.

• Ka lōʻihi o ka lau, unuhi ʻia mai nā lōʻihi i ana mua ʻia hōʻoia ʻia ka hopu pololei ʻana.

• Hoʻohana ʻelua V-Clamp:

• I kekahi mau hihia, Hiki ke hoʻohana ʻia ka lua V-Clamp e hoʻoponopono i ke koena MR.

• ʻElua V-Clamp, hoʻokomo i kahi kokoke loa i ka mea hoʻopili mua a pela no ka hana ana.

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ʻO ke kaʻina hana TEER i nā ʻīlio e mālama i ka degenerative mitral regurgitation (DMR) hoʻohana ʻia no kēia manawa, noninvasive he ʻenehana. ʻO kēia kaʻina hana:

• Mini thoracotomy ve hoʻokokoke naʻau transapical hana ʻia me.

• TEE a me ka fluoroscopy kuhikuhi ʻia me.

• Hoʻokomo pololei i ka mea V-Clamp a lanakila i ka hopu ʻana i nā lauhoʻoholo i ka holomua o ka hana.

• ʻO ka lua V-Clamp, hiki ke hoʻohana no ka hoʻoponopono hou.

• ʻO ka anticoagulation me ka heparin, pale i ka hoʻokumu ʻana o clot i ka wā o ke kaʻina hana.

ʻO kēia kaʻina hana e hoʻolōʻihi i ke ola o nā ʻīlio me ka maʻi degenerative mitral valve ve hoʻomaikaʻi i ka maikaʻi o ke ola he mana nui no.

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Nā ʻatikala ʻē aʻe āu e makemake ai

• Lapaau o ka Pulmonary Stenosis
• ʻO kāu kaʻina hana hoʻokolokolo cardiology
• Pani ʻia o ka Patent Ductus Arteriosus (PDA)
• Transesophageal Echocardiography (TEE)
• Myxomatous Mitral Valve Disease (MMVD)

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"ʻO ke kanaka moʻomeheu ka mea ʻaʻole ʻoluʻolu iā ia iho."

Andre Gide

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