Nthawi yowerengera: 10 miniti
Zamkatimu
- Tanthauzo ndi Mbiri
- Kugwiritsa Ntchito mwa Anthu
- Zotsogola mu Veterinary Cardiology
- Maphunziro a Zachipatala
- Zofunikira Zoyenera Poyambira
- Njira Zodziwira Zomwe Zimayambitsa Mitral Regurgitation (MR)
- Njira Zowunika
- Mitral Functional Anatomy ndi Ubale Wake ndi Kupambana
- Kuwunika Komaliza kwa Kukonza kwa Edge-to-Edge
- Transcatheter Edge-to-Edge Mitral Valve Repair (TEER)
- Kuchita Opaleshoni
- Kuyang'ana ndi Kuwona Ma angles
- Anticoagulation
- Kuyeza kwa V-Clamp ndi Kuyika
- Makulidwe a V-Clamp:
- Kutsegula Bowo la Mtima ndi Kukonzekera Njira Yolowera:
- Mitral Valve Passage:
- Kuyika kwa V-Clamp:
- Kujambula Kapepala ka Mitral Valve:
- Kuwongolera ndi Kuunika
Tanthauzo ndi Mbiri
Kukonza ma valve a mitral m'mphepete Lingalirolo linapangidwa koyamba ndi dokotala wa opaleshoni ya mtima Ottavio Alfieri ndi, kukonza prolapse (prolapse) ya kapepala kakang'ono ka mitral valve Zaperekedwa ngati njira yothetsera izi. Muukadaulo uwu, kapepala kamene kamatuluka kumasokedwa pa kapepala koyang’anizana nalo Awiri-orifice (double-orifice) mitral valve amapangidwa.
Kutsatira njira yokonza opaleshoniyi, Kukonza ma valve a transcatheter-to-edge mitral valve (TEER) luso linapangidwa. Njira iyi, njira yosasokoneza wakhala njira wamba mankhwala odwala anthu.
Kugwiritsa Ntchito mwa Anthu
Njira ya TEER mwa anthu, Chida cha MitraClip ikugwiritsidwa ntchito.
• EVEREST yotheka kuphunziraUwu ndiye kafukufuku woyamba wopangidwa kuti awunike mphamvu ndi chitetezo cha chipangizo cha MitraClip.
• EVEREST II ndi COAPT Maphunziro awiri akuluakulu otchedwa, zatsimikizira mphamvu za TEER pochiza matenda oopsa a mitral regurgitation (MR) ndipo zapangitsa kuti anthu ambiri azivomereza..
• KUCHEZA mwa anthu kulibenso Njira yotetezeka komanso yothandiza yothandizira mitral regurgitation amagwiritsidwa ntchito kwambiri ngati.
Zotsogola mu Veterinary Cardiology
Kupambana komwe kunachitika mwa anthu kunapangitsa kuti pakhale chipangizo chofanana ndi chachipatala cha Chowona Zanyama. Chipangizochi chinapangidwira agalu. Canine Mitral V-Clamp chipangizo.
Canine Mitral V-Clamp Chipangizo
• Chipangizochi, Adapangidwa kuti azichiza matenda a mitral valve (DMVD) mwa agalu.
• Choyamba, Mu 1 agalu ndi siteji B8 alibe matenda mitral valve Pakufufuza koyambirira, kugwiritsa ntchito ndi mphamvu ya chipangizocho kunawonetsedwa.
Maphunziro a Zachipatala
• Agalu omwe ali ndi mitral regurgitation (MR) Kuyesa kutheka kwa chipangizo cha V-Clamp zakwaniritsidwa.
• Cholinga cha kafukufukuyu chinali kuwunika momwe chipangizochi chilili chotetezeka komanso chogwira ntchito mwa agalu.
• Kukonza ma valve a Transcatheter m'mphepete mpaka m'mphepete (TEER), Choyamba ndondomeko yopangidwa mwa anthundi Chida cha MitraClip Amagwiritsidwa ntchito kwambiri pochiza kwambiri mitral regurgitation (MR) pogwiritsa ntchito
• Muchipatala, Canine Mitral V-Clamp chipangizo, mofanana ndi agalu degenerated mitral valve matenda (DMVD) adapangidwa kuti azichiza.
• Maphunziro oyambirira, kugwiritsa ntchito chipangizochi kwa agalu zikuwonetsa kuti ndizoyenera komanso zotetezeka.
• Kugwiritsa ntchito bwino kwa chipangizocho, Kafukufuku woyembekezeka mwa agalu omwe ali ndi mitral regurgitation amawunikidwa ndi.
Izi zikuchitika mu Veterinary cardiology kutuluka kwa njira zatsopano, zosagwiritsidwa ntchito pochiza matenda owonongeka a mitral valve Imakhala.
Zofunikira Zoyenera Poyambira
Degenerative mitral regurgitation (DMR) agalu amene adzachitiridwapo kanthu chifukwa cha Njira ya American Society of Echocardiography (ASE) ya mitral regurgitation (MR) mwa anthu ziyenera kukwaniritsa zomwe zasinthidwa.
• Agalu mu gawo la ACVIM B2 kapena Camawerengedwa kuti ndi woyenera kulowererapo kwa mitral.
• Late stage D kapena Agalu omwe ali ndi Atrial Fibrillation (AF), chifukwa cha mitral samatengedwa kukhala oyenerera.
Njira Zodziwira Zomwe Zimayambitsa Mitral Regurgitation (MR)
Kuti mudziwe kuopsa kwa MR zoposera chimodzi ziyenera kuunika. Zofunikira zothandizira kwambiri MR Icho chiri motere:
• Holosystolic, ma eccentric amitundu othamanga omwe amakhudza khoma kapena kupitilira 50% ya dera lapakati lamtundu wa jet
• E-wave wamkulu mitral inflow velocity ≥1.0 m/s
• Mbiri yayikulu ya holosystolic triangular regurgitation pa Doppler wave wave
• Kagawo ka regurgitation (RF) ≥50% (Proximal Isovelocity Surface Area (PISA) imatha kuyezedwa ndi volumetric kapena ndi Doppler)
• Regurgitation voliyumu (RVol) ≥1.0 mL/kg
Njira Zowunika
• Kuwunika kwa Colour Flow Doppler:
• Muzithunzi zosiyanasiyana za systolic ve kupindula koyenera ndi makonda a Nyquist iyenera kuyesedwa ndi.
• Kuwunika kuopsa kwa MR ndi chithunzi chimodzi kungapangitse MR kuwoneka wovuta kwambiri kuposa momwe zilili.
• Regurgitation Fraction (RF) Kuyeza:
• RF, PISA, Simpson volumetric ndi/kapena Doppler njira zoyezeka.
• Kuyeza RF ndi njira zingapo, kumawonjezera kudalirika kwa kuwunika.
• Vena Contracta (VC) Width, Regurgitant Volume (RVol) ndi Effective Regurgitant Orifice Area (ERO):
• Miyezo iyi ikhoza kuganiziridwa, koma zimasiyanasiyana malinga ndi kukula kwa wodwala.
• Malire enieni a agalu sanatsimikizidwebe mokwanira..
• Kumanzere kwa Ventricle (LV) ndi Left Atrium (LA) Kukulitsa:
• Kumanzere kwa ventricular diastolic mkati mwake (LVIDdN)> 1.9 kukhala
• Chiŵerengero cha kumanzere kwa atrium/mng'oma (LA:Ao)>2.0 kukhala
• Kusintha kumeneku kumachitika chifukwa cha MRI ndi zosintha zachiwiri ve matenda aakulu ve mankhwala ogwiritsidwa ntchito Izo zimatengera.
• Systolic Function Indices:
• Kumanzere kwa ventricular ejection (LVEF) <50% kukhala
• Kumanzere kwa ventricular end-diastolic diameter (LVIDsN)> 1.0 kukhala
• Izi zikhoza kukhala zisonyezero kuti kuthekera kwa kuchepetsa MR ndi kofooka.
Mitral Functional Anatomy ndi Ubale Wake ndi Kupambana
• Mitral valve ntchito anatomy, mu ndondomeko ya TEER ndi chimodzi mwazofunikira kwambiri zomwe zimatsimikizira kupambana ndi zotsatira.
• Makulidwe a zida zomwe zilipo agalu Amapangidwa mu 14 mm, 16 mm ndi 18 mm.
• Chithunzi cha apical inflow-outflow echocardiographic, The anterior-posterior (AP) mitral annulus m'mimba mwake pakati pa systole ndi pakati pa 14-20 mm. Zimalimbikitsidwa kukhala nazo.
Kuwunika Komaliza kwa Kukonza kwa Edge-to-Edge
• Mapangidwe a anatomical ogwira ntchito ayenera kuyesedwa ndi transesophageal echocardiography (TEE) musanayambe ndondomekoyi..
• TEE ikuwonetsa momveka bwino kukula, mawonekedwe a thupi ndi kuyenerera kwa valve ya mitral pa ndondomekoyi.
1. Ndi Agalu Ati Amene Ali Oyenerera TEER?
• Agalu mu ACVIM B2 ndi C magawo ndi omwe ali oyenera kwambiri.
• Agalu Ali mu Gawo D ve Agalu omwe ali ndi Atrial Fibrillation (AF)sali oyenerera ku TEER.
2. Zoyenera Kuwona Kuvuta kwa MR
• Zofunikira monga holosystolic colored flow jets, regurgitation fraction (RF), vena contracta wide ndi regurgitation volume (RVol) zimagwiritsidwa ntchito.
• M'malo mwa chithunzi chimodzi, kuwunika pogwiritsa ntchito njira zingapo analimbikitsa.
3. Kuunika kwa Functional Anatomical Structure
• Agalu omwe ali ndi mawonekedwe oyenera a anatomical (gulu lobiriwira) ndondomeko bwino mlingo ndi apamwamba.
• Agalu omwe ali ndi thupi lokwanira bwino (gulu lachikasu) angapindule ndi ndondomekoyi, koma zoopsa zake zimakhala zazikulu.
• Agalu okhala ndi mawonekedwe osayenera (gulu lofiira) Sali oyenerera ku TEER.
4. Transesophageal Echocardiography (TEE) Evaluation
• TEE, ndiye chida chofunikira kwambiri pakuwunika komaliza ndi kupanga zisankho.
• TEE, imapereka kuwunika kolondola kwa morphology, kukula ndi kapangidwe ka valvu ya mitral.
Munjira iyi, kusankha kolondola kwa odwala, ntchito anatomical kapangidwe ve kuunika kwadongosolo ndi zinthu zofunika zomwe zimakhudza mwachindunji kupambana. Kupanga kuwunika koyenera, kumawonjezera mwayi woti njirayi ikhale yopambana komanso moyo wabwino wa wodwalayo.
Transcatheter Edge-to-Edge Mitral Valve Repair (TEER)
Njira ya TEER mwa agalu, onse opaleshoni pansi, mini thoracotomy ve njira ya transapical cardiac Galuyo amasungidwa pamalo otetezeka panthawiyi. kumanja lateral decubitus malo (atagona kumanja kwake).
Kuchita Opaleshoni
1. Kutsimikiza kwa Intercostal Space:
• Mulingo woyenera kwambiri wa intercostal danga nthawi zambiri 7th intercostal space ndi dera lino lateral fluoroscopic kujambula ve transthoracic echocardiography (TTE) imatsimikiziridwa pogwiritsa ntchito .
2. Matenda a thoracotomy:
• 3-4 cm intercostal thoracotomy incision, amapangidwa chabe dorsal (kumtunda) kwa sternum.
3. Kutsegula Pericardium:
• The pericardium imatsegulidwa ndi kudulidwa ku incision kukwera pamwamba pa mtima amaperekedwa.
4. Kuzindikira Malo Oboola Mtima:
• Chithunzi cha Biplane TEE cha ventricle yakumanzere ndi vavu ya mitral The mtima puncture malo anatsimikiza ndi kunja psinjika ya mtima pa
• Kutuluka-kutuluka ve mu mawonekedwe a commissural Dera lomwe limayenderana ndi ndege ya mitral valve limatengedwa kuti ndiloyenera kwambiri.
5. Matrix Stitch pa Heart Hole:
• Ndi 4-0 polypropylene ulusi awiri pledget imalimbitsa matrix, imayikidwa pamalo abwino kwambiri opumira ndikumangika ndi makina oyendera alendo.
Kuyang'ana ndi Kuwona Ma angles
• Kujambula kwa Fluoroscopic:
• Fluoroscopic angle, kawirikawiri 10 ° chiwombankhanga ve 0 ° mpaka 10 ° kumanzere kwakumbuyo kwa oblique imayikidwa ngati.
• Malinga ndi momwe wodwalayo amaonera, mbali iyi 90 ° mpaka 100 °.
• Transesophageal Echocardiography (TEE) Kujambula:
• Mawonedwe a Bi-planar mu ndege zoyendera komanso zotuluka analandira.
• Mitral valve komanso atatu-dimensional (3D) ndi nkhope (nkhope yakutsogolo) imawunikidwa ndi maonekedwe ake.
• Msempha nthawi zambiri umakhala pamalo a 9 koloko, motero kuonetsetsa kusuntha kwa chipangizo pakati pa TEE ndi zithunzi za fluoroscopic.
Anticoagulation
• Heparin Bolus Administration:
• Musanalowe mu mtima, kudzera m'mitsempha 50 U/kg heparin Chapatsidwa.
Kuyeza kwa V-Clamp ndi Kuyika
Makulidwe a V-Clamp:
• 14mm, 16mm ndi 18mm Pali mitundu itatu ya V-Clamp yomwe ilipo.
• Kukula kwa V-Clamp, Anterior-posterior (AP) mitral valve diameter pakatikati pa systole pamawonekedwe a TEE otulukandipo mtengo uwu umatsimikiziridwa molingana ndi 1-2 mm imachotsedwa.
Kutsegula Bowo la Mtima ndi Kukonzekera Njira Yolowera:
• Catheter yokhala ndi singano ya 18 G mtima umalasidwa ndi.
• 0.035" 50 cm J-tip guidewire, imadutsa mu catheter ndikutumizidwa ku ventricle yakumanzere.
• Catheter imachotsedwa ndi kupita ku waya wowongolera Woyambitsa 14F amapita ku ventricle yakumanzere..
Mitral Valve Passage:
• Waya wa J-nsonga ndi dilator, ndi kalozera wapadera wa mitral ndi nsonga yofewa ya nitinol chasinthidwa.
• Wotsogolera, mothandizidwa ndi TEE amadutsa retrogradely kudzera mitral valve ndipo mchira wolowera umakwezedwa kumanzere kwa atrium.
Kuyika kwa V-Clamp:
• V-Clamp yogawa zidaimaperekedwa kumanzere kwa atrium kudzera pa sheath yolowera.
• Kugwiritsa ntchito zida za V-Clamp, TEE ndi fluoroscopy medial-lateral, anterior-posterior (AP) ndi kuzungulira imayikidwa mumayendedwe.
Kujambula Kapepala ka Mitral Valve:
• Mikono yapansi, imadutsa mu mitral valve ndikuyika pansi pa timapepala.
• Kenako, manja apamwamba amatsitsidwa kuti agwire timapepala ndipo V-Clamp yatsekedwa.
• Timapepala tagwidwa, Kutsimikiziridwa ndi TEE ndi fluoroscopy Kenako V-Clamp maloko.
Kuwongolera ndi Kuunika
• Kutsimikizira Mapepala:
• Zigawo zosakanizidwa (zaulere) za mapepala apambuyo ndi apambuyo amayezedwa ndi kutalika kwa kapepala kameneka kumapitirira 4 mm zimatsimikiziridwa ngati pakufunika.
• Utali wa timapepala, kuchotsedwa pautali woyezedwa kale kugwidwa kolondola kumatsimikiziridwa.
• Kugwiritsa Ntchito Kwachiwiri kwa V-Clamp:
• Nthawi zina, V-Clamp yachiwiri ingagwiritsidwe ntchito kukonza MR otsalawo.
• V-Clamp Yachiwiri, kuyikidwa pafupi kwambiri ndi chipangizo choyamba cholumikizira ndipo ndondomeko yomweyo imatsatiridwa.
Njira ya TEER mwa agalu kuchiza degenerative mitral regurgitation (DMR) amagwiritsidwa ntchito masiku ano, osasokoneza ndi luso. Njira iyi:
• Mini thoracotomy ve njira ya transapical cardiac imachitidwa ndi.
• TEE ndi fluoroscopy imayendetsedwa ndi.
• Kuyika bwino kwa V-Clamp ndikujambula bwino timapepalazimatsimikizira kupambana kwa ntchitoyo.
• Yachiwiri V-Clamp, angagwiritsidwe ntchito kuwongolera kwina.
• Anticoagulation ndi heparin, imalepheretsa kupanga magazi panthawi ya ndondomekoyi.
Njira iyi kukulitsa moyo wa agalu omwe ali ndi matenda osokonekera a mitral valve ve kukhala ndi moyo wabwino ali ndi kuthekera kwakukulu kwa.
Nkhani Zina Zomwe Mungakonde nazo
"Munthu wotukuka ndi munthu amene sakhutira ndi iye yekha."
Andre Gide
