TEER Mitral Valve Mmezi (V-Clamp)

Oge agụpụtara echere: 10 Nkeji

Nkọwa na akụkọ ihe mere eme

Ndozi valvụ mitral n'akụkụ ruo n'akụkụ Onye dọkịta na-awa obi chepụtara echiche a nke mbụ Ottavio Alfieri site, iji dozie prolapse (prolapse) nke mpempe akwụkwọ ihu nke valvụ mitral Atụpụtara ya dị ka ihe ngwọta ịwa ahụ maka nke a. Na teknụzụ a, A na-adụkọta akwụkwọ nta ahụ gbadara n'akwụkwọ nta ahụ chere ya ihu A na-emepụta valvụ mitral abụọ-orifice (okpukpu abụọ-orifice).

Site na usoro nrụzi ịwa ahụ nke ọma, Ndozi valvụ transcatheter n'akụkụ ruo n'ọnụ (TEER) e mepụtara usoro. Usoro a, ụzọ na-adịghị emerụ ahụ aghọwo usoro ọgwụgwọ a na-ahụkarị na ndị ọrịa mmadụ.

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Jiri n'ime mmadụ

Usoro TEER n'ime mmadụ, Ngwa MitraClip eji eme ya.

• EKWU mmuo ihe gbasara ikeNke a bụ ọmụmụ ihe mbụ emere iji nyochaa nrụpụta na nchekwa nke ngwaọrụ MitraClip.

• EVEREST II na COAPT Ihe ọmụmụ abụọ dị mkpa akpọrọ, egosila ịdị irè nke TEER na ọgwụgwọ mitral regurgitation siri ike (MR) ma mee ka a nabata ya n'ọtụtụ ebe..

• Ụjọ n'ime mmadụ adịkwaghị Nhọrọ ọgwụgwọ dị mma ma dị mma maka regurgitation mitral siri ike a na-ejikarị eme ihe dị ka.

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Ọganihu na ọrịa obi anụmanụ

Ihe ịga nke ọma e nwetara n'ime mmadụ mere ka e nwee ụdị ngwaọrụ a na ọgwụ anụmanụ. Emebere ngwaọrụ a maka nkịta. Canine Mitral V-Clamp ngwaọrụ.

Ngwa Canine Mitral V-Clamp

• Ngwaọrụ a, Emepụtara iji gwọọ ọrịa mitral valve degenerated (DMVD) na nkịta.

• Nke mbụ, N'ime nkịta 1 nwere ogbo B8 mebiri emebi mitral valve ọrịa N'ime ọmụmụ ihe mbụ, egosiri ike na ịdị irè nke ngwaọrụ ahụ.

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Ọmụmụ ụlọ ọgwụ

• N'ime nkịta nwere nnukwu regurgitation mitral (MR) Ọnwụnwa enwere ike ime nke ngwaọrụ V-Clamp a ghọtara.

• Ebumnuche nke ọmụmụ ihe a bụ iji nyochaa ka ngwaọrụ ahụ si dị mma ma dị irè n'ime nkịta.

• Ndozi valvụ transcatheter n'akụkụ ruo n'ọnụ (TEER), Nke mbụ usoro e mepụtara n'ime mmadụna Ngwa MitraClip A na-eji ya agwọ ọrịa mitral regurgitation (MR) nke ukwuu

• Na ọgwụgwọ ọrịa anụmanụ, Ngwa Canine Mitral V-Clamp, n'otu aka ahụ na nkịta Ọrịa mitral valvụ mebiri emebi (DMVD) e mere iji gwọọ.

• Ọmụmụ izizi, iji ngwaọrụ a na nkịta na-egosi na ọ dabara na nchekwa.

• Ngwa ngwa na ịdị irè nke ngwaọrụ ahụ sara mbara, Ọmụmụ ihe a na-atụ anya ime na nkịta nwere nnukwu regurgitation mitral a na-enyocha ya.

Mmelite ndị a na ọrịa obi obi mpụta ọhụrụ, nhọrọ ndị na-adịghị emerụ ahụ maka ọgwụgwọ ọrịa mitral valve mebiri emebi na-enye.

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Usoro ntozu maka mmalite

Degenerative mitral regurgitation (DMR) nkịta ndị a ga-edo onwe ha n'aka n'ihi Amụma American Society of Echocardiography (ASE) maka nnukwu regurgitation mitral (MR) n'ime mmadụ ga-egbo mkpa emegharịziri.

• Nkịta nọ na ACVIM ogbo B2 ma ọ bụ Ca na-ewere ya dị ka onye ndoro-ndoro maka enyemaka mitral.

• Oge ikpeazụ D ma ọ bụ Nkịta nwere fibrillation atrial (AF), maka enyemaka mitral a naghị ewere ya dị ka ndị kwesịrị ekwesị.

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Nchọpụta nchoputa maka mmụgharị Mitral siri ike (MR)

Iji chọpụta ịdị njọ nke MR A ghaghị ịtụle ihe karịrị otu njirisi. Usoro na-akwado MR siri ike Ọ bụ dị ka ndị:

• Holosystolic, eccentric acha jets eruba na-emetụta mgbidi ma ọ bụ karịa 50% nke mpaghara ọdụ ụgbọ mmiri iyi etiti

• E-wave na-achịkwa mitral inflow ọsọ ≥1.0 m/s

• Profaịlụ regurgitation nke holosystolic triangular siri ike na ebili mmiri Doppler na-aga n'ihu

• Iberibe regurgitation (RF) ≥50% Enwere ike tụọ mpaghara Isovelocity dị nso (PISA) nke ọma ma ọ bụ site na Doppler.

• Regurgitation olu (RVol) ≥1.0 ml/kg

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Ụzọ nyocha

• Nyocha Doppler agba agba:

• Na foto systolic dị iche iche ve uru kwesịrị ekwesị na ntọala Nyquist kwesịrị iji nyochaa.

• Iji otu onyonyo nyochaa ogo MR nwere ike mee ka MR yie ka ọ dị njọ karịa ka ọ dị n'ezie.

• Ntụle ntakiri regurgitation (RF).:

• RF, PISA, Simpson volumetric na/ma ọ bụ ụzọ Doppler ihe atụ.

• Atụ RF na ọtụtụ ụzọ, na-abawanye ntụkwasị obi nke nyocha.

• Vena Contracta (VC) obosara, Regurgitant olu (RVol) na Mpaghara Orifice Regurgitant dị irè (ERO):

Enwere ike iburu n'uche nha ndị a, mana dịgasị iche dabere na nha onye ọrịa.

• ekpebiela oke ụkpụrụ maka nkịta..

• Ventricle aka ekpe (LV) na Atrium (LA) aka ekpe:

• Dayameta dị n'ime oghere ventricular aka ekpe (LVIDdN)>1.9 ịbụ

• Oke mgbọrọgwụ atrium/aortic aka ekpe (LA: Ao)> 2.0 ịbụ

• Mgbanwe ndị a na-eme n'ihi MRI bụ mgbanwe nke abụọ ve chronicity nke ọrịa ve ọgwụgwọ etinyere Ọ na-adabere.

• Indices ọrụ systolic:

• Iberibe mkpochapụ ventricular aka ekpe (LVEF) <50% ịbụ

• Dayameta njedebe-diastolic ventricular aka ekpe (LVIDsN)>1.0 ịbụ

• Akụkụ ndị a nwere ike ịbụ ihe na-egosi na ike mbelata MR adịghị ike.

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Mitral Functional Anatomy na Mmekọrịta ya na ihe ịga nke ọma

• Mitral valve arụrụ arụ ọrụ, na usoro TEER bụ otu n'ime ihe kachasị mkpa na-ekpebi ihe ịga nke ọma na nsonaazụ.

• Akụkụ nke ngwaọrụ nkịta dị Emebere ya na 14 mm, 16 mm na 18 mm.

• Onyonyo echocardiographic nke mbata na-apụ apụ, Dayameta nke anterior-posterior (AP) mitral annulus n'etiti systole bụ n'etiti 14-20 mm. A na-atụ aro ka ịnwe.

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Ntụle ikpeazụ maka ndozi Edge-to-Edge

• Ekwesịrị iji transesophageal echocardiography (TEE) nyochaa nhazi anatomical na-arụ ọrụ tupu usoro ahụ..

• TEE na-egosi n'ụzọ doro anya nha, arụ ọrụ ahụ na adabara valvụ mitral maka usoro ahụ.

1. Kedu nkịta ndị tozuru oke maka TEER?

• Nkịta na ACVIM B2 na C nkebi bụ ndị kacha dabara adaba.

• Nkịta nọ na Stage D ve Nkịta nwere fibrillation atrial (AF)erughị eru maka TEER.

2. Usoro maka inyocha ịdị njọ nke MR

• A na-eji njirisi dị ka jets agba agba holosystolic, akụkụ regurgitation (RF), obosara vena contracta na regurgitation volume (RVol).

• Kama otu onyonyo, nyocha site na iji ọtụtụ ụzọ kwadoro.

3. Nyocha nke Ọdịdị Anatomical Na-arụ Ọrụ

• N'ime nkịta nwere usoro anatomical kwesịrị ekwesị (ụdị akwụkwọ ndụ akwụkwọ ndụ) usoro ịga nke ọma ọnụego dị elu.

• Nkịta nke ụkpụrụ iwu dabara adaba (ụdị edo edo) nwere ike irite uru na usoro ahụ, mana ihe egwu dị ukwuu.

• Nkịta nwere usoro anatomical na-ekwesịghị ekwesị (ụdị uhie) Ha erughị eru maka TEER.

4. Nyochaa Echocardiography nke Transesophageal (TEE).

• TEE, bụ ngwá ọrụ kachasị mkpa na nyocha ikpeazụ na nke ime mkpebi.

• TEE, na-enye ntule ziri ezi nke morphology, nha na nhazi nke valvụ mitral.

N'ime usoro a, nhọrọ onye ọrịa ziri ezi, arụ ọrụ anatomical Ọdịdị ve nyocha tupu usoro bụ isi ihe na-emetụta ihe ịga nke ọma ozugbo. Na-eme nyocha ziri ezi, na-abawanye ohere nke usoro ahụ na-aga nke ọma na ndụ onye ọrịa.

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Ndozi Mitral Valve Transcatheter Edge-to-Edge (TEER)

Usoro TEER na nkịta, mgbanwụ izugbe n'okpuru, obere thoracotomy ve ụzọ obi transapical A na-ejide nkịta ahụ n'ebe dị nchebe n'oge usoro ahụ. n'akụkụ aka nri decubitus (dina n'akụkụ aka nri ya).

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Ntinye aka na ịwa ahụ

1. Mkpebi nke Intercostal Space:

Oghere intercostal kacha mma na-abụkarị Oghere intercostal nke 7 na mpaghara a onyonyo fluoroscopic mpụta ve transthoracic echocardiography (TTE) ejiri .

2. Thoracotomy:

• Ihe mbepụ intercostal thoracotomy nke 3-4 cm, a na-eme ya naanị azụ azụ (akụkụ elu) nke sternum.

3. Na-emeghe pericardium:

• A na-emeghe pericardium na sutured na mbepụ mbuli elu nke obi obi a na-enye.

4. Na-ekpebi ebe mkpọpu obi:

• Foto Biplane TEE nke ventricle ekpe na mitral valve A na-ekpebi ebe mgbapu obi site na mkpakọ mpụta nke obi n'oge

• Mbubata-mkpọpu ve na commissural echiche A na-ewere mpaghara kwụ n'akụkụ ụgbọ elu valvụ mitral dị ka ebe ntụpọ kacha mma.

5. Matrix Stitch na oghere obi:

• Na 4-0 polypropylene eri abụọ Nkwado matriks akwadoro nkwa, a na-etinye ya n'ime ebe kachasị mma ma jiri usoro njem nlegharị anya sie ike.

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Nlele na nlele akụkụ

• Ihe onyonyo nke fluoroscopic:

• Fluoroscopic akụkụ, na-emekarị 10° cranial ve 0° ruo 10° akaekpe n'ihu oblique atọrọ ka .

• Site n'echiche onye ọrịa, akụkụ a 90° ruo 100°.

• Transesophageal Echocardiography (TEE) onyonyo:

• Echiche bi-planar n'ime ụgbọ elu commissural na nke na-asọpụta nwetara.

• Mitral valve kwa akụkụ atọ (3D) na ihu A na-enyocha ihe oyiyi (ihu ihu).

• A na-edobekarị aorta n'elekere itoolu, si otú a na-ahụ na mmegharị nke ngwaọrụ n'etiti TEE na fluoroscopic oyiyi.

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Mgbochi obi

• Nlekọta nke Heparin Bolus:

• Tupu abanye n'ime obi, intravenously 50 U / kg heparin Ọ na-nyere.

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Ntụnye na ntinye V-Clamp

Akụkụ V-Clamp:

• 14mm, 16mm na 18mm Enwere nha V-Clamp atọ dị.

• V-mkpado nha, Dayameta valvụ mitral nke azụ-azụ (AP) na etiti systole na nlele TEE na-apụ apụ.a na-ekpebikwa uru a dịka A na-ewepụ 1-2 mm.

Imeghe oghere obi na nkwadebe nke ụzọ ntinye:

• Otu catheter nwere agịga 18G e ji dụpuo obi.

• 0.035" 50 cm J-ndụmọdụ ndu, na-agafe na catheter ma ziga ya na ventricle aka ekpe.

• A na-ewepụ catheter na n'elu waya ndu Onye nrụpụta 14F na-aga n'ihu na ventricle aka ekpe..

ngafe Mitral Valve:

• waya J-tipped na dilator, ya na ntuziaka ụzọ mitral pụrụ iche nwere ntụ nkata nitinol dị nro agbanweela.

• Ntuziaka, site n'enyemaka nke TEE gafere retrogradely site na mitral valve na n'ọbọ ohere na-aga n'ihu n'ime atrium aka ekpe.

Ndobe V-Mkpuchi:

• Ngwa nkesa V-Clampa na-ebuga ya na atrium aka ekpe site n'ọbọ ohere.

• Iji V-Clamp ogwe aka, TEE na fluoroscopy medial-mpụta, anterior-posterior (AP) na ntụgharị atọrọ na nghazi.

Mkpesa mpempe akwụkwọ Mitral Valve:

• Ogwe aka dị ala, na-agafe valvụ mitral ma tinye ya n'okpuru mpempe akwụkwọ.

• Mgbe ahụ, a na-agbada ogwe aka elu ka ọ jide akwụkwọ nta ahụ na V-Clamp mechiri.

• A na-ejide mpempe akwụkwọ. Ekwenyere na TEE na fluoroscopy Ọzọkwa V-mkpọchi mkpọchi.

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Njikwa na Nyocha

• Nkwenye njide mpempe akwụkwọ:

• A na-atụ akụkụ nke mpempe akwụkwọ ihu na azụ (n'efu) na ogologo mpempe akwụkwọ ejidere karịrị 4 mm kwadoro ka ọ dị mkpa.

• Ogologo mpempe akwụkwọ, ewepụrụ n'ogologo atụnyere na mbụ akwadoro njide ziri ezi.

• Ojiji V-Clamp nke abụọ:

• N'ọnọdụ ụfọdụ, Enwere ike iji V-Clamp nke abụọ dozie MR nke fọdụrụ.

• Mkpuchi V nke abụọ, etinyere nso dị ka o kwere mee na ngwaọrụ mkpọchi nke mbụ na otu usoro a na-agbaso.

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Usoro TEER na nkịta iji gwọọ degenerative mitral regurgitation (DMR) eji maka oge a, na-adịghị emerụ ahụ bụ usoro. Usoro a:

• Obere thoracotomy ve ụzọ obi transapical a na-eme ya na.

• TEE na fluoroscopy na-eduzi ya.

• Ndokwa ngwaọrụ V-Clamp ziri ezi yana ijide akwụkwọ nta ahụ nke ọmana-ekpebi ihe ịga nke ọma nke ọrụ ahụ.

• V-Clamp nke abụọ, enwere ike iji maka mgbazi ọzọ.

• Anticoagulation na heparin, na-egbochi ịmepụta clot n'oge usoro ahụ.

Usoro a na-agbatị ndụ ndị nkịta nwere ọrịa mitral valve degenerative ve melite ogo ndụ nwere nnukwu ikike maka.

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Akụkọ ndị ọzọ nwere ike ịmasị gị

• Ọgwụgwọ Stenosis Pulmonary
• Usoro nyocha gbasara obi gị
• Mmechi nke Patent Ductus Arteriosus (PDA)
• Echocardiography nke transesophageal (TEE)
• Myxomatous Mitral Valve Ọrịa (MMVD)

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"Onye nwere omenala bụ onye na-enweghị afọ ojuju naanị onwe ya."

Andre Gide

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