TEER Mitral Valve Tapia (V-Rawhi)

Te taima panui: 10 meneti

Whakamaramatanga me te Htori

Tapa-ki-te-te-te-te-a-te-te-te-te-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-te whakatikatika I whakawhanakehia te kaupapa tuatahi e te taote ngakau Ottavio Alfieri na, ki te whakatika i te paheketanga (prolapse) o te pepa o mua o te mitral valve Kua whakaarotia hei otinga pokanga mo tenei. I roto i tenei tikanga, ka tuituia te pepa kua paheke ki te pepa kei te taha Ka waihangahia he riu mitral rua-orifice (double-orifice).

Whai muri i tenei mahi whakatikatika pokanga angitu, transcatheter tapa-ki-te-te-te-te-a-te-a-te-a-te-a-te-a-te-a-te-a-te-whakapai (TEER) i whakawhanakehia te hangarau. Ko tenei tikanga, he huarahi whakaeke kore kua waiho hei tikanga maimoatanga noa i roto i nga turoro tangata.

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Whakamahia i roto i te Tangata

Ko te tukanga TEER i roto i te tangata, taputapu MitraClip kua oti te whakamahi.

• EVEREST rangahau whaihuaKoinei te rangahau tuatahi i whakahaerehia hei arotake i te kaha me te haumaru o te taputapu MitraClip.

• EVEREST II me COAPT E rua nga rangahau nui i tapaina, kua whakamatauhia te whai huatanga o TEER i roto i te maimoatanga o te regurgitation mitral kino (MR) me te mea kua tino whakaaetia e ia..

• TEER i roto i te tangata kua kore He kōwhiringa maimoatanga haumaru me te whai hua mo te regurgitation mitral kino whakamahia whānuitia hei.

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Ko nga ahunga whakamua i roto i nga mahi a te Taonga Taonga

Ko te angitu i tutuki i roto i te tangata i arahi ki te whanaketanga o tetahi taputapu rite i roto i te rongoa kararehe. I hangaia tenei taputapu mo nga kuri. Canine Mitral V-Clamp taputapu.

Pūrere Canine Mitral V-Clamp

• Ko tenei taputapu, I whakawhanakehia hei rongoa i te mate mitral valve degenerated (DMVD) i roto i nga kuri.

• Tuatahi, I roto i nga kuri e 1 me te wahanga B8 kua heke te mate mitral valve I roto i te rangahau tuatahi, i whakaatuhia te whakamahinga me te whai hua o te taputapu.

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Akoranga Haumanu

• I roto i nga kuri he nui te regurgitation mitral (MR) He whakamatautau whaihua mo te taputapu V-Clamp kua tutuki.

• Ko te kaupapa o tenei rangahau he arotake i te haumaru me te whai hua o te taputapu ki roto i nga kuri.

• Whakapai i te taha-ki-te-te-te-te-te-te-te-a-te-a-te-taahi (TEER), Tuatahi he tukanga i whakawhanakehia i roto i te tangataa taputapu MitraClip Ka whakamahia nuitia ki te hamani i te regurgitation mitral taumaha (MR) ma te whakamahi

• I roto i te rongoa kararehe, taputapu Canine Mitral V-Clamp, he pera ano ki nga kuri mate mitral valve mate (DMVD) kua hoahoatia hei rongoa.

• Nga akoranga tuatahi, te whakamahinga o tenei taputapu ki nga kuri e whakaatu ana e tika ana, e haumaru ana.

• He whanui ake te whakamahi me te whai huatanga o te taputapu, Te rangahau whaihuatanga i roto i nga kuri he nui te regurgitation mitral ka arotakehia me.

Ko enei whanaketanga i roto i te mate pukupuku kararehe te puta mai o nga whiringa hou, kaore i te whakaekea mo te maimoatanga o te mate o te mitral valve degenerated E whakarato ana.

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Paearu Whakaaetanga mo te Whakaoho

Regurgitation mitral degenerative (DMR) kuri e ka waiho i raro i te wawaotanga e tika ana ki American Society of Echocardiography (ASE) paearu mo te regurgitation mitral nui (MR) i roto i te tangata me tutuki nga paearu kua urutau.

• Ko nga kuri kei te wahanga ACVIM B2, C raneika whakaarohia he kaitono mo te wawaotanga mitral.

• Te wa mutunga D ranei nga kurī whai atrial fibrillation (AF), mo te wawaotanga mitral kaore e kiia he kaitono pai.

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Paearu tātaritanga mo te Regurgitation Mitral Tino (MR)

Hei whakatau i te kaha o te MR neke atu i te kotahi nga paearu me arotake. Paearu tautoko MR kino Ko reira e whai ake:

• Ko te Holosystolic, he rere kee te tae ka pa ki te pakitara ranei nui ake i te 50% o te rohe rererangi awa tae ki waenganui

• Te ngaru-e te tere o te rerenga mitral ≥1.0 m/s

• Ko te regurgitation tapatoru holosystolic kaha i runga i te ngaru Doppler tonu

• Hautau Regurgitation (RF) ≥50% (PISA) Ka taea te ine ma te reo, ma te Doppler ranei)

• Rōrahi Regurgitation (RVol) ≥1.0 mL/kg

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Nga Tikanga Aromātai

• Te Aromātai Doppler Rere Tae:

• I roto i nga whakaahua systolic rereke ve painga tika me nga tautuhinga Nyquist me arotakehia me.

• Ko te aromatawai i te taumahatanga o te MR me te ahua kotahi ka hee pea te ahua o te MR ki te tino kino.

• Te Inenga Hautau Regurgitation (RF).:

• RF, PISA, Simpson volumetric me/ranei tikanga Doppler ka taea te ine.

• Te ine i te RF me nga tikanga maha, ka piki ake te pono o te arotake.

• Vena Contracta (VC) Whānuitanga, Regurgitant Volume (RVol) and Effective Regurgitant Orifice Area (ERO):

• Ka taea te whai whakaaro ki enei inenga, engari he rereke i runga i te rahi o te manawanui.

• Ko nga uara tepe tika mo nga kuri kaore ano kia tino whakatauhia..

• Te Puawai Maui (LV) me te Atrium Maui (LA) Whakanuia:

• Mauī ventricular diastolic diameter roto (LVIDdN)> 1.9 te

• Atrium maui/owehenga pakiaka aortic (LA:Ao) >2.0 te

• Ka puta enei huringa na te MRI he huringa tuarua ve te mau tonu o te mate ve te maimoatanga i tono Tei te reira.

• Tohu Mahi Systolic:

• Ko te hautanga tukunga ventricular maui (LVEF) <50% te

• Mauī ventricular mutunga-diastolic diameter (LVIDsN)> 1.0 te

• Ko enei tawhā pea he tohu he ngoikore te kaha ki te whakaheke i te MR.

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Mitral Functional Anatomy me Tona Hononga ki te Angitu

• Mitral valve anatomy mahi, i roto i te tukanga TEER ko tetahi o nga tino whakatau mo te angitu me nga hua.

• Te rahi o nga taputapu kuri e waatea ana I hangaia i roto i te 14 mm, 16 mm me te 18 mm.

• Apical inflow-outflow echocardiographic image, Ko te diameter o mua-muri (AP) mitral annulus i waenganui-systole kei waenganui i te 14-20 mm E taunaki ana kia whai.

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Te Aromatawai Whakamutunga mo te Whakatikatika Tapa-ki-Tahi

• Me arotakehia te hanganga tinana mahi me te transesophageal echocardiography (TEE) i mua i te mahi..

• He tino marama ake te whakaatu a TEE i te rahi, te aahuatanga me te pai o te puera mitral mo te mahi.

1. Ko wai nga kuri e tika ana mo te TEER?

• Nga kuri kei roto i nga wahanga ACVIM B2 me C ko nga kaitono tino pai.

• Nga kuri kei te wahanga D ve nga kurī whai atrial fibrillation (AF)ehara i te kaitono tika mo TEER.

2. Paearu mo te Aromatawai i te Kaha o MR

• Ka whakamahia nga paearu penei i te rere rere o te tae holosystolic, te hautau regurgitation (RF), te whanui o te vena contracta me te rōrahi regurgitation (RVol).

• Engari he ahua kotahi, te arotake ma te whakamahi i nga tikanga maha tūtohutia.

3. Te Aromātai o te Hanganga Anatomical Mahi

• I roto i nga kurī e tika ana te hanganga tinana (kāwai kākāriki) he teitei ake te reeti angitu o te tukanga.

• Ko nga kuri e tika ana te hanganga ture (kawai kowhai) ka whai hua pea i te tukanga, engari he nui ake nga raru.

• Nga kuri kaore e tika ana te hanga tinana (waahanga whero) Ehara ratou i te kaitono tika mo TEER.

4. Transesophageal Echocardiography (TEE) Aromātai

• TEE, Ko te taputapu tino nui i roto i te arotake whakamutunga me te wahanga whakatau.

• TEE, ka whakarato i te aromatawai tika mo te ahua, te rahi me te hanganga o te mitral valve.

I roto i tenei tukanga, tika te kowhiringa o nga turoro, hanganga tinana mahi ve te aro mātai i mua i te hātepe ko nga huānga taketake e pa ana ki te angitu. Te mahi aromatawai tika, ka whakanui ake i te angitu o te tukanga me te oranga o te manawanui.

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Whakapai Tape-ki-te-Tapa Mitral Valve (TEER)

Te tukanga TEER i roto i nga kuri, rewharewha whānui i raro, thoracotomy paku ve huarahi transapical cardiac Ka mau te kurī ki tētahi wāhi haumaru i te wā e mahi ana. i roto i te tuunga decubitus taha matau (e takoto ana i tona taha matau).

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Te wawaotanga pokanga

1. Te Whakataunga o te Mokowā Intercostal:

• Ko te nuinga o nga wa ko te waahi intercostal tino pai 7th intercostal wāhi me tenei rohe whakaahua fluoroscopic lateral ve transthoracic echocardiography (TTE) ka manatoko ma te whakamahi.

2. Toracotomy:

• He 3-4 cm te werohanga thoracotomy intercostal, he mea hanga noa ki te tuara (te taha o runga) o te sternum.

3. Te whakatuwhera i te Pericardium:

• Ka tuwhera te pericardium ka tuia ki te werohanga te teitei o te tihi o te ngakau ka whakaratohia.

4. Te Whakatau i te Waenga Taonga Ngakau:

• Biplane TEE ahua o te ventricle maui me te mitral valve Ko te waahi werohanga ngakau ka whakatauhia e te kopeketanga o waho o te ngakau i te waa

• Rerenga-puta ve i roto i nga tirohanga commissural Ko te waahi e tika ana ki te waka rererangi mitral ka kiia ko te waahi pai rawa atu.

5. Tuia Matrix i runga i te Kohao Manawa:

• Me te miro polypropylene 4-0 rua oati whakakaha tuitui matrix, ka whakanohoia ki roto i te waahi pupuhi tino pai, ka whakakikitia ki te punaha tourniquet.

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Te Tirohanga me te Tirohanga Koki

• Whakaahua Fluoroscopic:

• Koki fluoroscopic, te tikanga 10° cranial ve 0° ki te 10° te taha maui ki mua kua whakaritea hei.

• Mai i te tirohanga a te manawanui, tenei koki 90° ki te 100°.

• Transesophageal Echocardiography (TEE) Whakaahua:

• Tirohanga rua-papa i roto i nga rererangi commissural me te rere-roto whiwhi.

• Mitral valve hoki ahu-toru (3D) me te kanohi (te kanohi o mua) ka aromatawaihia e tona ahua.

• I te nuinga o te wa ka whakaritea te aorta ki te 9 karaka, na reira ka whakarite i te nekehanga tukutahi o te taputapu i waenga i te TEE me nga whakaahua fluoroscopic.

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Te whakaheke toto

• Heparin Bolus Whakahaere:

• I mua i te urunga ki roto i te ngakau, whakaroto 50 U/kg heparin Kei te hoatu te reira.

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V-Rawhi Ine me te Whakanoho

Ahu Rawhi-V:

• 14mm, 16mm me 18mm E toru nga rahi V-Clamp e waatea ana.

• Rahi Rawhi-V, Tuhinga o mua-muri (AP) mitral valve diameter i waenganui-systole i runga i te rere-rerenga TEE tirohangaa ka whakatauhia tenei uara i runga i Ka tangohia te 1-2 mm.

Te Whakatuwhera i te Puka Manawa me te Whakaritenga o te Ara Whakauru:

• He catheter me te ngira 18 G ka werohia te ngakau.

• 0.035” 50 cm te aratohu J-matamata, ka tukuna i roto i te catheter ka tukuna ki te ventricle maui.

• Ka tangohia te catheter a ki runga i te waea arahi Ko te whakaurunga 14F kua neke atu ki te ventricle maui..

Mitral Valve Passage:

• waea J-taipped me te dilator, me te aratohu ara mitral motuhake me te pito kete kete nitinol ngawari ka hurihia.

• Arataki, me te awhina a TEE haere whakamuri i roto i te mitral valve a ka anga whakamua te wahapu ki te atrium maui.

Whakanohonga Rawhi-V:

• V-Rawhi taputapu tohatohaka tukuna ki te atrium maui ma te putunga uru.

• Te whakamahi i nga ringaringa V-Clamp, TEE me te fluoroscopy medial-lateral, mua-muri (AP) me te hurihuri kua whakaritea ki te takotoranga.

Mitral Valve Pepatuhi Hopu:

• Nga ringa o raro, ka tukuna i roto i te mitral valve ka tuu ki raro i nga pepa.

• Na, ka tuku iho nga ringaringa o runga ki te hopu i nga pepa a kua katia te V-Clamp.

• Ka mau nga panui, I whakamanahia e TEE me te fluoroscopy katahi V-Rawhi raka.

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Whakahaere me te Aromātai

• Manatokonga Hopu Pepa:

• Ka inehia nga waahanga kore-kore (kore) o te pepa o mua me o muri nui atu i te 4 mm te roa o te pepa i hopukina ka whakapumautia ina tika.

• Te roa o te pepa, ka tangohia mai i nga roa i whanganga i mua manatokohia te hopu tika.

• Tuarua V-Rawhi Whakamahi:

• I etahi wa, Ka taea te whakamahi V-Clamp tuarua hei whakatika i te toenga MR.

• Rawhi-V Tuarua, whakanohoia kia tata ki te taputapu awhi tuatahi a ka pera ano te mahi.

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Te tukanga TEER i roto i nga kuri ki te rongoa i te regurgitation mitral degenerative (DMR) whakamahia mo nga mea hou, kore kino he tikanga. Tenei tukanga:

• Mini thoracotomy ve huarahi transapical cardiac ka mahia me.

• TEE me te fluoroscopy ka arahina ki.

• Te whakanoho tika i te taputapu V-Clamp me te hopu angitu o nga panuika whakatau i te angitu o te mahi.

• He V-Rawhi tuarua, ka taea te whakamahi mo etahi atu whakatikatika.

• Ko te anticoagulation me te heparin, ka aukati i te hanga o te toka i te wa e mahi ana.

Tenei tukanga te whakaroa ake i te oranga o nga kurī e mate ana i te mate mitral valve ve whakapai ake i te kounga o te oranga he kaha nui mo.

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Ētahi atu Tuhinga ka hiahia pea koe

• Te maimoatanga o te Stenosis Pulmonary
• Tō Tukanga Whakamātautau Cardiology
• Katinga o Patent Ductus Arteriosus (PDA)
• Transesophageal Echocardiography (TEE)
• Myxomatous Mitral Valve Disease (MMVD)

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"Ko te tangata whai tikanga he tangata kare e ngata ki a ia ano."

Andre Kiriki

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