Dayactirka TEER Mitral Valve (V-Clamp)

Waqtiga akhriska ee la qiyaasay: 10 daqiiqadii

Sharaxaada iyo Taariikhda

Cidhif-ilaa-cirif mitral valve dayactirka Fikradda waxaa markii ugu horreysay sameeyay dhakhaatiirta qalliinka wadnaha Ottavio Alfieri by, hagaajinta soo dhicista (soo dhicis) ee xaashida hore ee waalka mitral Waxaa loo soo jeediyay sidii xal qalliin loogu talagalay Farsamadan, Warqadda soo baxday waxay ku tolan tahay warqadda ka soo horjeeda. Waxaa la sameeyay laba-orifice (double-orifice) mitral valve.

Iyadoo la raacayo habkan dayactirka qalliinka ee lagu guuleystay, Dayactirka waalka mitral-ka-ilaa-geeska ah (TEER) farsamada ayaa la sameeyay. Farsamadan hab aan duullaan lahayn Waxay noqotay habka daawaynta caadiga ah ee bukaanka bini'aadamka.

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Isticmaalka in Aadanaha

Habka TEER ee aadanaha, Qalabka MitraClip Waxaa lagu sameeyaa iyadoo la isticmaalayo.

• Daraasadda suurtagalka ah ee EVERESTTani waa daraasadii ugu horeysay ee la sameeyo si loo qiimeeyo waxtarka iyo badbaadada qalabka MitraClip.

• EVEREST II iyo COAPT Laba daraasaad oo waaweyn oo la yiraahdo waxay caddeeyeen waxtarka TEER ee daawaynta mitral regurgitation daran (MR) waxayna keentay aqbalaaddeeda baahsan..

• TEER bani'aadamku hadda ma jiro Doorasho badbaado leh oo wax ku ool ah oo daaweyn ah oo loogu talagalay regurgitation mitral daran Aad baa loo isticmaalaa.

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Horumarka Caafimaadka Xoolaha ee Wadnaha

Guusha aadanaha ayaa keentay in la sameeyo qalab la mid ah daawada xoolaha. Qalabkan waxaa si gaar ah loogu talagalay eeyaha. Canine Mitral V-Clamp qalab.

Canine Mitral V-Clamp Device

• Qalabkan Loo sameeyay in lagu daweeyo cudurka mitral valve ee xumaada (DMVD) ee eeyaha.

• Marka hore, In 1 eey oo qaba cudurka mitral valve ee sii xumaanaya marxaladda B8 Daraasad horudhac ah, suurtogalnimada iyo waxtarka qalabka ayaa lagu muujiyay.

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Daraasadaha Caafimaadka

• Eeyaha leh regurgitation mitral daran (MR) Tijaabada suurtogalka ah ee suurtogalka ah ee qalabka V-Clamp ayaa la fuliyay.

Ujeeddada daraasaddan waa in la qiimeeyo sida badbaadada iyo waxtarka u leh aaladda eyda.

• Dayactirka waalka mitral-ka-ilaa-geeska ah (TEER), Marka hore Nidaam lagu sameeyay aadanahawaa iyo Qalabka MitraClip Waxaa si weyn loo isticmaalaa in lagu daweeyo regurgitation mitral daran (MR).

• Daawada xoolaha, Qalabka Canine Mitral V-ClampSidoo kale eeyaha Cudurka mitral waalka ee xumaaday (DMVD) Waxaa loogu talagalay in lagu daweeyo.

• Daraasado horudhac ah, isticmaalka qalabkan eeyaha waxay tusinaysaa in ay suurtagal tahay oo ammaan tahay.

Isticmaalka balaadhan iyo waxtarka qalabka, Daraasada suurtogalka ah ee mustaqbalka ee eeyaha leh regurgitation mitral daran. Waxaa lagu qiimeeyaa .

Horumarintan ku saabsan wadnaha xoolaha Soo ifbaxa fursado cusub oo aan fiicneyn oo loogu talagalay daaweynta cudurka mitral valve ee sii xumaanaya. Waxay bixisaa.

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Shuruudaha u-qalmitaanka ee Hindisaha

Degenerative mitral regurgitation (DMR) Eeyaha ku dhici doona faragelin ay sabab u tahay Bulshada Mareykanka ee Echocardiography (ASE) shuruudaha loogu talagalay dib-u-celinta mitral daran (MR) ee bini'aadamka waa inay buuxiyaan shuruudaha la waafajiyay.

• Eeyaha ku jira ACVIM heerka B2 ama Cwaxaa loo tixgaliyaa musharaxa faragelinta mitral.

• marxaladda dambe D veya eeyaha leh fibrillada atrial (AF)faragelinta mitral looma tixgeliyo musharaxiin ku habboon.

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Shuruudaha ogaanshaha Mitral Regurgitation (MR) ee daran

Si loo go'aamiyo darnaanta MRI In ka badan hal shuruud ayaa u baahan in la qiimeeyo. Shuruudaha taageeraya MR Waa sida soo socota:

• Holosystolic, dayuuradaha midabka eccentric ee hadda saameeya gidaarka veya Aagga jet-socodka midabka dhexe ee ka weyn 50%

• E-mowjada ugu badan ee xawaaraha socodka mitral ≥1.0 m/s

• Astaanta regurgitation ee saddex-geesoodka holosystolic ee kacsan ee hirarka joogtada ah ee Doppler

• Jajabka regurgitation (RF) ≥50% (PISA) waxaa lagu qiyaasi karaa mugga ama Doppler

• Mugga dib u soo celinta (RVol) ≥1.0 mL/kg

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Hababka Qiimaynta

• Qiimaynta Socodka Midabka Doppler:

• Sawirada systolic ee kala duwan ve faa'iidada ku habboon iyo goobaha Nyquist waa in lagu qiimeeyaa.

• Qiimaynta darnaanta MRI oo leh hal sawir waxa laga yaabaa inay si khalad ah u keento MRI inay u muuqato mid ka daran sida dhabta ah.

• Cabbirka Jajabka Regurgitation (RF):

• RF, PISA, Simpson volumetric iyo/ama hababka Doppler la qiyaasi karo.

• Ku cabbirida RF oo leh habab badan, waxay kordhisaa isku halaynta qiimaynta.

• Vena Contracta (VC) Ballaca, Mugga Dib-u-habaynta (RVol) iyo Aagga Orifice Regurgitant ee Waxtarka leh (ERO):

• Cabiraadahan waa la tixgelin karaa, laakiin Way kala duwan tahay iyadoo ku xidhan xajmiga bukaanka.

• Qiimaha xadka saxda ah ee eeyaha weli si buuxda looma go'aamin.

• Ventricle bidix (LV) iyo bidix Atrium (LA) ballaarinta:

• Dhexroorka hawo-mareenka bidix ee diastole (LVIDdN)>1.9 isagoo

• Qiyaasta xididka bidix ee atrium / aortic (LA: Ao)> 2.0 isagoo

Isbeddelladani waxay ku dhacaan natiijada MRI. waa isbedel labaad ve xanuunka daba-dheeraada ve daawaynta lagu dabaqay Waxay ku xidhan tahay.

• Tilmaamaha Shaqada Systolic:

• Jajabka ka bixista wadnaha ee bidix (LVEF) <50% isagoo

• Dhexroorka hawo-mareenka bidix ee dhamaadka-diastolic (LVIDsN)>1.0 isagoo

• Halbeegyadan ayaa laga yaabaa inay muujinayaan in suurtagalnimada dhimista MR ay daciif tahay.

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Mitral Functional Anatomy iyo Xidhiidhka ay la leedahay Guusha

• Mitral valve anatomy functional, habka TEER waa mid ka mid ah kuwa ugu muhiimsan ee go'aamiya guusha iyo natiijooyinka.

• Cabirka aaladaha eyda ee la heli karo Waxaa loogu talagalay sida 14 mm, 16 mm iyo 18 mm.

• Sawirka echocardiographic ka soo gelida apical, inta u dhaxaysa 14-20 mm ee hore- danbe (AP) dhexroorka mitral annulus ee bartamaha-systole Waxaa lagu talinayaa in la haysto.

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Qiimaynta u dambaysa ee Dayactirka Cidhifka-ilaa-Ege

• Qaab dhismeedka anatomical functional waa in lagu qiimeeyaa transesophageal echocardiography (TEE) kahor nidaamka..

• TEE waxay bixisaa sawir cad oo ku saabsan cabbirka, anatomy, iyo ku habboonaanta waalka mitral ee nidaamka.

1. Eeygee ku haboon TEER?

• Eeyaha ku jira ACVIM B2 iyo C marxaladaha waa musharaxiinta ugu haboon.

• Eeyaha ku jira marxaladda D ve eeyaha leh fibrillada atrial (AF)kuma haboona musharaxiinta TEER.

2. Shuruudaha lagu qiimeeyo darnaanta MR

• Shuruudaha sida jets socodka midabka holosystolic, jajabka regurgitation (RF), ballaca vena contracta iyo mugga regurgitation (RVol) ayaa la isticmaalaa.

Halkii hal sawir, Qiimaynta iyadoo la isticmaalayo wax ka badan hal hab lagu taliyay.

3. Qiimaynta Qaabdhismeedka Anatomical ee shaqaynaya

• Eeyaha leh qaab-dhismeed ku habboon anatomical (qayb cagaaran) Heerka guusha habraaca ayaa ka sarreeya.

• Eyda dhisme dhexdhexaad ah (qayb jaale ah) laga yaabaa in laga faa'iidaysto habraaca, laakiin khatartu way ka weyn tahay.

• Eyda leh qaab dhismeed aan habboonayn (qayb cas) Kuma haboona musharaxiinta TEER.

4. Qiimaynta Echocardiography ee Transesophageal (TEE).

• TEE, Waa qalabka ugu muhiimsan ee qiimaynta ugu dambaysa iyo heerka go'aan qaadashada..

• TEE, waxay ogolaataa in si sax ah loo qiimeeyo qaab-dhismeedka, cabbirka iyo qaab-dhismeedka mitral valve.

Habkan, xulashada bukaanka saxda ah, qaab dhismeedka anatomical functional ve qiimaynta nidaamka kahor Kuwani waa walxaha asaasiga ah ee sida tooska ah u saameeya guusha. Samaynta qiimayn sax ahwaxay kordhisaa suurtogalnimada in habraaca lagu guuleysto iyo tayada nolosha bukaanka.

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

Habka TEER ee eeyaha, suuxinta guud hoosta, mini thoracotomy ve habka wadnaha transapical Waxa lagu fuliyaa . Eey inta lagu jiro habraaca ku yaal booska decubitus lateral midig (dhinaca midig u jiifa) waa la hayaa.

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Faragelinta Qalliinka

1. Go'aaminta booska Intercostal:

Aagga intercostal ee ugu fiican ayaa badanaa ah Meesha 7aad ee intercostal iyo aaggan sawirka fluoroscopic lateral ve Echocardiography transthoracic (TTE) waxaa lagu xaqiijiyaa iyadoo la isticmaalayo.

2. Thoracotomy:

• Jeexitaan 3-4 cm intercostal thoracotomyWaxa la sameeyaa kaliya dhabarka (qaybta sare) ee sternum.

3. Furitaanka Pericardium:

• Pericardium wuu furmay oo lagu tolay meesha la jeexay saarista wadnaha waa la bixiyaa.

4. Go'aaminta Meesha Wadnaha laga Dalooliyo:

• Sawirka biplane TEE ee ventricle bidix iyo mitral valve Goobta daloolinta wadnaha waxaa lagu go'aamiyaa cadaadiska dibadda ee wadnaha inta lagu jiro hawsha.

• qulqulka-ka-baxa ve xagga aragtida guud Gobol u siman dayuurada mitral valve ayaa loo arkaa barta dalool ee ugu fiican.

5. Tollida Matrix ee Daloolka Wadnaha:

• Iyadoo 4-0 dun polypropylene ah laba Ballanqaadka la xoojiyay tolitaanka matrixkawaxaa la geliyaa meesha ugu fiican ee daloolinta waxaana lagu adkeeyaa nidaamka dalxiiska.

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Daawashada iyo Daawashada Xaglaha

• Sawirka Fluoroscopic:

• xagasha fluoroscopic, sida caadiga ah 10° cranial ve 0° ilaa 10° bidix ee hore ee dabada ayaa lagu wadaa .

• Marka laga eego dhinaca bukaanka, xagashan waa 90 ° ilaa 100 °.

• Sawirka Echocardiography ee Transesophageal (TEE).:

• Sawirka labada diyaaradood ee ku jira commissural iyo diyaaradaha qulqulaya helay.

• Mitral valve sidoo kale saddex-cabbir (3D) wejiga Waxaa lagu qiimeeyaa muuqaalkeeda (dhinaca hore).

• Aorta waxaa badanaa lagu dejiyaa booska 9 (saac u jihaysan), sidaas darteed hubinta dhaqdhaqaaqa isku midka ah ee qalabka ee u dhexeeya TEE iyo sawirada fluoroscopic.

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xinjirowga lidka ku ah

• Maamulka Heparin Bolus:

Kahor intaadan gelin wadnaha, xididada 50 U/kg oo heparin ah la siiyo.

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Qiyaasta V-Clamp iyo Meelaynta

Cabbirrada V-Clamp:

• 14mm, 16mm iyo 18mm Lagu heli karo saddex cabbir V-Clamp:

• Cabbirka V-Clamp, Anterior-posterior (AP) dhexroorka waalka mitral ee bartamaha-systole ee muuqaalka TEE ee qulqulayawaxaa lagu go'aamiyaa si waafaqsan qiimahan 1-2 mm waa la saaraa.

Furitaanka Daloolka Wadnaha iyo Diyaarinta Jidka Galitaanka:

• Kateetarka oo leh irbad 18G ah Wadnaha ayaa lagu mudaa.

• 0.035" 50 cm J-tip silig hagahawaxaa la sii maraa kateetarka waxaana loo diraa hawo-mareenka bidix.

• Kateetarka ayaa laga saaray oo gal siliga hagaha Hordhac 14F ah ayaa u hormaray dhanka hawo-mareenka bidix.

Ka gudub Mitral Valve:

• J-tip silig iyo dilator, oo leh hage marin gaar ah oo mitral ah oo leh caarada dambiisha nitinol jilicsan waa la bedelay.

• Hagaha, iyadoo la kaashanayo TEE dib u soo mariyo waalka mitral-ka iyo galka gelitaanka ayaa loo hormariyay atrium bidix.

Meelaynta V-Clamp:

• Qalabka qaybinta V-ClampWaxa loo diraa atrium-ka bidix iyada oo loo marayo marinka.

Isticmaalka gacmaha V-Clamp, TEE iyo fluoroscopy Dhexdhexaad-dhinac, hore- danbe (AP) iyo wareeg waxaa loo dejiyay hanuunin.

Qabashada Warqadaha Mitral Valve:

• gacmaha hooseWaxa la dhex maraa waalka mitral waxaana la dhigaa warqadaha hoostooda.

• Markaa, gacmaha sare waa la soo dejiyaa si loo qabto warqadaha V-Clamp-ga waa la xiray.

• Warqadaha waa la qabtaa, Waxaa xaqiijiyay TEE iyo fluoroscopy ka dibna V-Clamp waa quful.

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Xakamaynta iyo Qiimaynta

• Xaqiijinta Qabashada Warqadaha:

• Qaybaha aan la cadaadin (free) ee warqadaha hore iyo dambe waa la cabbiraa iyo dhererka warqadaha la qabtay oo ka weyn 4 mm waa la hubiyaa sida loo baahan yahay.

• Dhererka warqadaha, oo laga jarayo dhererkii hore loo qiyaasay Qabashada saxda ah waa la xaqiijiyay.

• Isticmaalka labaad ee V-Clamp:

• Xaaladaha qaarkood, V-Clamp labaad ayaa loo isticmaali karaa si loo saxo MRI hadhaaga ah.

V-Clamp labaad, xajinta ugu horeysa waxaa la dhigayaa meel u dhow qalabka sida ugu macquulsan waxaana la raacayaa nidaam isku mid ah.

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Habka TEER ee eeyaha daaweynta dib-u-celinta mitral regurgitation (DMR) casri ah, loo isticmaalo aan duullaan lahayn Waa farsamo. Habkan:

• Mini thoracotomy ve habka wadnaha transapical Waxa lagu fuliyaa .

• TEE iyo fluoroscopy waxaa haga.

• Meelaynta saxda ah ee qalabka V-Clamp iyo qabashada si guul leh warqadahaayaa go'aamisa guusha wax kala iibsiga.

• V-Clamp labaadwaxaa loo isticmaali karaa sixid dheeraad ah.

• xinjirowga lidka ku ah heparinwaxay ka hortagtaa xinjirowga dhiigga inta lagu jiro hawsha.

Habkan Kordhinta cimriga eeyaha qaba cudurka mitral valve ee xumaada ve hagaajinta tayada nolosha Waxay leedahay awood weyn

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Maqaallo kale oo laga yaabo inaad xiisaynayso

• Daawaynta stenosis sambabada
• Habka Baaritaanka Wadnahaaga
• Xiritaanka Patent Ductus Arteriosus (PDA)
• Echocardiography transesophageal (TEE)
• Cudurka Myxomatous Mitral Valve Disease (MMVD)

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"Qofka dhaqanka leh waa qof aan naftiisa oo keliya ku qanacsanayn."

André GIDE

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