TEER Mitral Valve Kho (V-Clamp)

Lub sijhawm nyeem ntawv kwv yees: 10 feeb

Txhais thiab Keeb Kwm

Ntug-rau-ntug mitral valve kho Lub tswv yim yog thawj zaug tsim los ntawm tus kws phais plawv Ottavio Alfieri: koj puas xav tau ntau tus thwjtim? los ntawm, kho prolapse (prolapse) ntawm daim ntawv anterior ntawm lub mitral valve Nws tau raug npaj los ua kev phais mob rau qhov no. Hauv cov txheej txheem no, daim ntawv prolapsed yog stitched rau nplooj ntawv opposite nws Ib tug ob-orifice (ob-orifice) mitral valve yog tsim.

Ua raws li txoj kev kho phais zoo no, Transcatheter ntug-rau-ntug mitral valve kho (TEER) txheej txheem tau tsim. Cov txheej txheem no, ib txoj kev tsis-invasive tau dhau los ua ib txoj kev kho mob hauv tib neeg cov neeg mob.

---

Siv nyob rau hauv tib neeg

Cov txheej txheem TEER hauv tib neeg, MitraClip ntaus ntawv ua tiav siv.

• EVEREST feasibility kawmNov yog thawj txoj kev tshawb fawb los ntsuas qhov ua tau zoo thiab kev nyab xeeb ntawm MitraClip ntaus ntawv.

• EVEREST II thiab COPT Ob txoj kev tshawb fawb loj muaj npe, tau ua pov thawj qhov ua tau zoo ntawm TEER hauv kev kho mob hnyav mitral regurgitation (MR) thiab tau coj mus rau nws qhov kev lees paub dav dav..

• TEER hauv tib neeg tsis muaj lawm Ib qho kev nyab xeeb thiab kev kho mob zoo rau kev mob hnyav mitral regurgitation yog dav siv raws li.

---

Kev nce qib hauv Veterinary Cardiology

Kev vam meej ua tiav hauv tib neeg tau ua rau kev txhim kho cov cuab yeej zoo sib xws hauv cov tshuaj kho tsiaj. Cov cuab yeej no tau tsim tshwj xeeb rau cov dev. Canine Mitral V-Clamp ntaus ntawv.

Canine Mitral V-Clamp Device

• Cov cuab yeej no, Tsim los kho degenerated mitral valve kab mob (DMVD) hauv dev.

• Ua ntej, Hauv 1 tus dev nrog theem B8 degenerated mitral valve kab mob Hauv kev tshawb fawb ua ntej, kev siv tau thiab kev ua tau zoo ntawm cov cuab yeej tau pom.

---

Kev tshawb fawb soj ntsuam

• Hauv cov dev uas muaj mob hnyav mitral regurgitation (MR) Kev sim ua tau zoo ntawm V-Clamp ntaus ntawv tau paub lawm.

• Lub hom phiaj ntawm txoj kev tshawb no yog los soj ntsuam seb lub cuab yeej muaj kev nyab xeeb thiab siv tau zoo npaum li cas hauv cov dev.

• Transcatheter ntug-rau-ntug mitral valve kho (TEER), Ua ntej ib tug txheej txheem tsim nyob rau hauv tib neegthiab MitraClip ntaus ntawv Nws yog dav siv los kho mob hnyav mitral regurgitation (MR) siv

• Hauv cov tshuaj kho tsiaj, Canine Mitral V-Clamp ntaus ntawv, zoo ib yam li dev Degenerated mitral valve kab mob (DMVD) yog tsim los kho.

• Kev tshawb fawb ua ntej, kev siv cov cuab yeej no hauv cov dev qhia tau hais tias nws muaj feem xyuam thiab muaj kev nyab xeeb.

• Kev siv dav dua thiab kev ua tau zoo ntawm cov cuab yeej, Txoj kev tshawb fawb yav tom ntej hauv cov dev nrog hnyav mitral regurgitation yog ntsuas nrog.

Cov kev txhim kho no hauv veterinary cardiology qhov tshwm sim ntawm cov kev xaiv tshiab, tsis muaj kev cuam tshuam rau kev kho mob ntawm degenerated mitral valve kab mob Nws muab.

---

Kev tsim nyog tau txais kev pab rau Startup

Degenerative mitral regurgitation (DMR) cov dev uas yuav raug kev cuam tshuam vim American Society of Echocardiography (ASE) cov txheej txheem rau mob hnyav mitral regurgitation (MR) hauv tib neeg yuav tsum ua kom tau raws li cov txheej txheem hloov.

• Cov dev hauv ACVIM theem B2 lossis Craug suav hais tias yog tus neeg sib tw rau mitral kev cuam tshuam.

• Late stage D los yog dev nrog atrial fibrillation (AF), rau mitral kev cuam tshuam tsis suav tias yog cov neeg sib tw tsim nyog.

---

Diagnostic Criteria for Severe Mitral Regurgitation (MR)

Txhawm rau txiav txim siab qhov hnyav ntawm MR ntau tshaj ib yam yuav tsum tau soj ntsuam. Cov txheej txheem txhawb nqa hnyav MR Nws yog raws li nram no:

• Holosystolic, eccentric xim xim ntws dav hlau cuam tshuam rau phab ntsa los yog ntau dua 50% ntawm qhov nruab nrab xim kwj dej dav hlau cheeb tsam

• E-wave dominant mitral inflow tshaj tawm ≥1.0 m / s

• Kev khaus holosystolic daim duab peb sab regurgitation profile ntawm nruam nthwv dej Doppler

• Regurgitation feem (RF) ≥50% (Proximal Isovelocity Surface Area (PISA) tuaj yeem ntsuas qhov ntim los yog Doppler)

• Regurgitation ntim (RVol) ≥1.0 mL / kg

---

Kev ntsuam xyuas

• Xim Flow Doppler Kev Ntsuas:

• Hauv cov duab systolic sib txawv ve tsim nyog nce thiab Nyquist nqis yuav tsum tau soj ntsuam nrog.

• Kev ntsuam xyuas MR qhov hnyav nrog ib daim duab tsis raug yuav ua rau MR tshwm sim hnyav dua li qhov tseeb.

• Regurgitation Fraction (RF) Kev Ntsuas:

• RF, PISA, Simpson volumetric thiab/los yog Doppler txoj kev olçülebilir ua.

• Ntsuas RF nrog ntau txoj kev, nce kev ntseeg siab ntawm kev ntsuam xyuas.

• Vena Contracta (VC) Dav, Regurgitant Volume (RVol) thiab Zoo Regurgitant Orifice Area (ERO):

• Cov kev ntsuas no tuaj yeem suav nrog, tab sis Nws txawv nyob ntawm seb tus neeg mob loj npaum li cas.

• Qhov tseeb txwv qhov tseem ceeb rau cov dev tseem tsis tau txiav txim siab tag nrho..

• Left Ventricle (LV) thiab Left Atrium (LA) Enlargement:

• Sab laug ventricular diastolic sab hauv txoj kab uas hla (LVIDdN) > 1.9 yuav tsum tau

• Sab laug atrium/aortic cag ratio (LA:Ao) > 2.0 yuav tsum tau

• Cov kev hloov no tshwm sim los ntawm MRI yog kev hloov pauv thib ob ve mob ntev ntawm tus kab mob ve kev kho mob thov nyob ntawm.

• Systolic Function Indices:

• Sab laug ventricular ejection feem (LVEF) <50% yuav tsum tau

• Sab laug ventricular kawg-diastolic txoj kab uas hla (LVIDsN) > 1.0 yuav tsum tau

• Cov kev txwv no yuav yog qhov qhia tau tias muaj peev xwm txo tau MR tsis muaj zog.

---

Mitral Functional Anatomy thiab Nws Kev Sib Raug Zoo rau Kev Ua Tau Zoo

• Mitral valve ua haujlwm anatomy, nyob rau hauv cov txheej txheem TEER yog ib qho tseem ceeb tshaj plaws txiav txim siab ntawm kev ua tiav thiab cov txiaj ntsig.

• Qhov ntev ntawm cov khoom siv dev muaj Tsim los ntawm 14 mm, 16 mm thiab 18 mm.

• Apical inflow-outflow echocardiographic duab, anterior-posterior (AP) mitral annulus txoj kab uas hla ntawm mid-systole yog nyob nruab nrab ntawm 14-20 mm Nws raug pom zoo kom muaj.

---

Kev ntsuam xyuas zaum kawg rau Edge-to-Edge Kho

• Kev ua haujlwm anatomical qauv yuav tsum tau soj ntsuam nrog transesophageal echocardiography (TEE) ua ntej tus txheej txheem..

• TEE kom meej meej qhia qhov loj, lub cev thiab qhov tsim nyog ntawm lub mitral valve rau cov txheej txheem.

1. Cov dev twg tsim nyog rau TEER?

• Cov dev hauv ACVIM B2 thiab C theem yog cov neeg sib tw tsim nyog tshaj plaws.

• Cov dev nyob rau theem D ve dev nrog atrial fibrillation (AF)tsis tsim nyog cov neeg sib tw rau TEER.

2. Kev ntsuas ntsuas qhov hnyav ntawm MR

• Cov txheej txheem xws li holosystolic coloured flow dav hlau, regurgitation feem (RF), vena contracta dav thiab regurgitation ntim (RVol) yog siv.

• Hloov ib daim duab, kev ntsuam xyuas siv ntau txoj kev pom zoo.

3. Kev ntsuam xyuas ntawm Kev Ua Haujlwm Anatomical Structure

• Nyob rau hauv cov dev uas tsim nyog anatomical qauv (ntsuab qeb) tus txheej txheem kev vam meej yog siab dua.

• Cov dev ntawm kev cai nruj me ntsis (qeb daj) tuaj yeem tau txais txiaj ntsig los ntawm cov txheej txheem, tab sis qhov kev pheej hmoo ntau dua.

• Cov dev nrog cov qauv tsis zoo anatomical (qeb liab) Lawv tsis yog cov neeg sib tw tsim nyog rau TEER.

4. Transesophageal Echocardiography (TEE) Kev Ntsuam Xyuas

• TSI, yog lub cuab yeej tseem ceeb tshaj plaws hauv kev ntsuam xyuas zaum kawg thiab kev txiav txim siab theem.

• TSI, muab kev ntsuam xyuas tseeb ntawm morphology, qhov loj thiab cov qauv ntawm mitral valve.

Hauv cov txheej txheem no, xaiv tus neeg mob raug, functional anatomical qauv ve kev ntsuam xyuas ua ntej yog cov ntsiab lus tseem ceeb uas cuam tshuam ncaj qha rau kev vam meej. Ua qhov kev ntsuam xyuas raug, nce qhov ua tau zoo ntawm cov txheej txheem ua tiav thiab tus neeg mob lub neej zoo.

---

Transcatheter Edge-rau-Edge Mitral Valve Kho (TEER)

TEER txheej txheem hauv dev, tshuaj loog hauv qab, mini thoracotomy ve transapical cardiac txoj kev Tus dev tau tuav hauv qhov chaw nyab xeeb thaum lub sijhawm ua haujlwm. nyob rau hauv txoj cai lateral decubitus txoj hauj lwm (dab ntawm nws sab xis).

---

Kev phais phais

1. Kev txiav txim siab ntawm Intercostal Space:

• Qhov chaw zoo intercostal feem ntau yog 7th intercostal chaw thiab thaj chaw no lateral fluoroscopic duab ve Transthoracic echocardiography (TTE) yog txheeb xyuas siv.

2. Thoracotomy:

• Ib qho 3-4 cm intercostal thoracotomy incision, yog ua tsuas yog dorsal (sab sauv) ntawm lub sternum.

3. Qhib Pericardium:

• Lub pericardium qhib thiab sutured rau qhov incision elevation ntawm lub plawv apex yog muab.

4. Txiav txim siab qhov Piercing Point:

• Biplane TEE duab ntawm sab laug ventricle thiab mitral valve Lub plawv puncture site yog txiav txim los ntawm sab nraud compression ntawm lub plawv thaum lub sij hawm

• Inflow-outflow ve nyob rau hauv commissural views Ib cheeb tsam perpendicular mus rau lub dav hlau mitral valve yog suav hais tias yog qhov zoo tshaj plaws puncture point.

5. Matrix Stitch ntawm Lub Plawv Qhov:

• Nrog 4-0 polypropylene xov ob Pledget reinforced matrix stitching, yog muab tso rau hauv qhov chaw zoo tshaj plaws puncture thiab nruj nrog lub tourniquet system.

---

Saib thiab saib lub kaum sab xis

• Fluoroscopic duab:

• Fluoroscopic kaum, feem ntau 10 ° cranial ve 0 ° txog 10 ° sab laug anterior oblique yog teem raws li.

• Los ntawm tus neeg mob qhov kev xav, lub kaum sab xis no 90 ° txog 100 °.

• Transesophageal Echocardiography (TEE).:

• Bi-planar saib hauv commissural thiab inflow-outflow dav hlau tau.

• Mitral valve kuj peb-dimensional (3D) lub ntsej muag (pem hauv ntej lub ntsej muag) duab raug soj ntsuam.

• Lub aorta feem ntau yog teem rau hauv 9 teev sawv ntxov, yog li kom ntseeg tau synchronized txav ntawm lub cuab yeej ntawm TEE thiab fluoroscopic cov duab.

---

Anticoagulation

• Heparin Bolus Administration:

• Ua ntej nkag mus rau hauv lub plawv, txhaj tshuaj 50 U / kg ntawm heparin Nws yog muab.

---

V-Clamp ntsuas thiab qhov chaw

V-Clamp Dimensions:

• 14mm, 16mm thiab 18mm Muaj peb qhov ntau thiab tsawg V-Clamp muaj.

• V-Clamp loj, Anterior-posterior (AP) mitral valve txoj kab uas hla ntawm nruab nrab-systole ntawm inflow-outflow TEE saibthiab tus nqi no yog txiav txim raws li 1-2 hli raug tshem tawm.

Qhib Lub Plawv Lub Qhov thiab Kev Npaj Txoj Kev Nkag Nkag:

• Lub catheter nrog 18 G koob lub plawv yog pierced nrog.

• 0.035 "50 cm J-tip guidewire, yog dhau los ntawm catheter thiab xa mus rau sab laug ventricle.

• Lub catheter raug tshem tawm thiab mus rau txoj kab qhia Tus 14F tus qhia tau nce mus rau sab laug ventricle..

Mitral Valve Txoj Kev:

• J-tipped hlau thiab dilator, nrog ib tug tshwj xeeb mitral passage qhia nrog ib tug mos nitinol pob tawb taub hloov.

• Qhia, nrog kev pab los ntawm TEE dhau retrogradely los ntawm mitral valve thiab cov ntaub ntawv nkag tau nce mus rau sab laug atrium.

V-Clamp Qhov Chaw:

• V-Clamp Distribution Apparatusyog xa mus rau sab laug atrium ntawm lub access sheath.

• Siv V-Clamp caj npab, TEE thiab fluoroscopy medial-lateral, anterior-posterior (AP) thiab rotational yog teem nyob rau hauv orientation.

Mitral Valve Leaflet Capture:

• Lub caj npab qis, yog dhau los ntawm lub mitral valve thiab muab tso rau hauv qab daim ntawv.

• Ces, sab caj npab yog qis dua los tuav cov nplooj ntawv thiab V-Clamp raug kaw.

• Daim ntawv raug ntes, Pom zoo los ntawm TEE thiab fluoroscopy thiab tom qab ntawd V-Clamp xauv.

---

Tswj thiab ntsuas

• Daim Ntawv Pov Thawj Capture:

• Cov ntaub ntawv uas tsis tau ntim (dawb) ntawm cov nplooj ntawv sab hauv thiab tom qab raug ntsuas thiab ntes cov nplooj ntawv ntev dua 4 mm tau lees paub tias tsim nyog.

• Daim ntawv ntev, rho tawm los ntawm qhov ntev tau ntsuas yav dhau los raug ntes raug pov thawj.

• Thib ob V-Clamp siv:

• Qee zaum, Qhov thib ob V-Clamp tuaj yeem siv los kho cov MR ntxiv.

• Thib ob V-Clamp, muab tso rau ze li sai tau rau thawj lub cuab yeej clamping thiab tib txoj kev ua raws li.

---

TEER txheej txheem hauv dev los kho degenerative mitral regurgitation (DMR) siv rau niaj hnub, tsis yog invasive yog ib txoj kev. Cov txheej txheem no:

• Mini thoracotomy ve transapical cardiac txoj kev yog ua nrog.

• TEE thiab fluoroscopy yog qhia nrog.

• Kev tso kawm kom raug ntawm V-Clamp ntaus ntawv thiab kev ua tiav ntawm cov nplooj ntawvtxiav txim siab qhov ua tiav ntawm kev ua haujlwm.

• Qhov thib ob V-Clamp, tuaj yeem siv rau kev kho ntxiv.

• Anticoagulation nrog heparin, tiv thaiv cov hlab ntsha thaum lub sijhawm ua haujlwm.

Cov txheej txheem no ncua lub neej ntawm dev nrog degenerative mitral valve kab mob ve txhim kho lub neej zoo muaj peev xwm zoo rau.

---

---

---

---

---

Lwm cov ntawv uas koj yuav txaus siab rau

• Kev Kho Mob Pulmonary Stenosis
• Koj Txoj Kev Xeem Cardiology
• Kaw ntawm Patent Ductus Arteriosus (PDA)
• Transesophageal Echocardiography (TEE)
• Myxomatous Mitral Valve Disease (MMVD)

---

"Ib tug neeg kab lis kev cai yog ib tug neeg uas tsis txaus siab rau nws tus kheej xwb."

Andre Gide

---