TEER Mitral Valve Repair (V-Clamp)

Khakanyo ea nako ea ho bala: 10 motsotso

Tlhaloso le Histori

Ho lokisoa ha valve ea mitral ho ea moeling Khopolo ena e ile ea qalisoa ka lekhetlo la pele ke ngaka e buoang pelo Ottavio Alfieri ka, ho lokisa prolapse (prolapse) ea pampitšana e ka pele ea valve ea mitral E hlahisitsoe e le tharollo ea ho buuoa bakeng sa sena. Ka theknoloji ena, pampitšana e phalletseng e rokelloa leqepheng le shebaneng le lona Ho entsoe mitral valve e nang le li-orifice tse peli (double-orifice).

Ka mor'a mokhoa ona o atlehileng oa ho lokisa opereishene, Tokiso ea mitral valve ea transcatheter ho tloha pheletsong ho isa pheletsong (TEER) mokhoa o ile oa ntlafatsoa. Mokhoa ona, mokgoa o sa hlaseleng e fetohile mokhoa o tloaelehileng oa phekolo ho bakuli ba batho.

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Sebelisa Bathong

Mokhoa oa TEER ho batho, Sesebelisoa sa MitraClip e etsoa ka ho sebelisa.

• EVEREST boithuto bo ka khonehangEna ke thuto ea pele e entsoeng ho lekola katleho le polokeho ea sesebelisoa sa MitraClip.

• EVEREST II le COAPT Lithuto tse peli tse kholo tse bitsitsoeng, e pakile katleho ea TEER kalafong ea mitral regurgitation e matla (MR) mme e entse hore e amoheloe hohle..

• HO HLAHALA ka har'a batho ha ho sa le joalo Khetho e bolokehileng le e sebetsang ea kalafo bakeng sa mitral regurgitation e matla e sebelisoa haholo joalo ka.

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Tsoelo-pele ho Veterinary Cardiology

Katleho e finyeletsoeng ho batho e ile ea lebisa ho hlahisoeng ha sesebelisoa se tšoanang sa bongaka ba liphoofolo. Sesebelisoa sena se etselitsoe lintja ka ho khetheha. Canine Mitral V-Clamp sesebelisoa.

Sesebelisoa sa Canine Mitral V-Clamp

• Sesebelisoa sena, E etselitsoe ho phekola lefu la degenerated mitral valve (DMVD) ho lintja.

• Ntlha ea pele, Ho lintja tse 1 tse nang le lefu la mitral valve la boemo ba B8 Phuputsong ea pele, ho sebetsa le ho sebetsa ha sesebelisoa ho bontšitsoe.

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Lithuto tsa Tleliniki

• Ho lintja tse nang le mitral regurgitation e matla (MR) Teko e lebelletsoeng ea ho khonahala ea sesebelisoa sa V-Clamp e phethahetse.

• Sepheo sa phuputso ena e ne e le ho lekola hore na sesebelisoa se bolokehile ebile se sebetsa hakae lintjang.

• Ho lokisoa ha mitral valve ho tloha moeling ho isa pheletsong ea transcatheter (TEER), Pele mokhoa o entsoeng bathongle Sesebelisoa sa MitraClip E sebelisoa haholo ho phekola mitral regurgitation e matla (MR) e sebelisang

• Ngakeng ea liphoofolo, Sesebelisoa sa Canine Mitral V-Clamp, ka ho tšoanang ho lintja lefu le fokotsehileng la mitral valve (DMVD) e etselitsoe ho phekola.

• Lithuto tsa pele, tšebeliso ea sesebelisoa sena ho lintja e bontša hore e sebetsa ebile e bolokehile.

• Tšebeliso e batsi le katleho ea sesebelisoa, Boithuto bo lebelletsoeng ho lintja tse nang le mitral regurgitation e matla e hlahlojoa ka.

Lintlafatso tsena ho cardiology ea bongaka ba liphoofolo ho hlaha ha mekhoa e mecha, e seng e hlaselang bakeng sa phekolo ea lefu la mitral valve le senyehileng E fana ka.

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Mekhoa ea ho Tšoaneleha bakeng sa ho Qala

Degenerative mitral regurgitation (DMR) lintja tse tlang ho kena lipakeng ka lebaka la Mekhoa ea American Society of Echocardiography (ASE) bakeng sa mitral regurgitation e matla (MR) ho batho. e tlameha ho finyella litekanyetso tse ikamahanyang le maemo.

• Lintja tse boemong ba ACVIM B2 kapa Ce nkoa e le mokhethoa bakeng sa ho kenella ha mitral.

• Boemo ba morao-rao D kapa lintja tse nang le atrial fibrillation (AF), bakeng sa ho kenella ha mitral ha ba nkoe e le bakhethoa ba loketseng.

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Mekhoa ea ho Hlahlobisisa bakeng sa ho khutlisetsoa ho matla ha Mitral (MR)

Ho fumana botebo ba MR lintlha tse fetang bonngoe li tlameha ho hlahlojoa. Lintlha tse tšehetsang MR ea matla Ho ka tsela e latelang:

• Holosystolic, li-jets tse phallang tse mebala-bala tse amang lebota kapa e kholo ho feta 50% ea sebaka sa jete sa mebala e bohareng

• E-wave e laolang mitral inflow velocity ≥1.0 m/s

• Boemo bo matla ba holosystolic triangular regurgitation ho Doppler wave wave

• Karolo ea ho khutlisa (RF) ≥50% (Proximal Isovelocity Surface Area (PISA) e ka lekanyetsoa ka volumetric kapa ka Doppler)

• Molumo oa ho khutlisa (RVol) ≥1.0 mL / kg

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Mekhoa ea Tlhahlobo

• Tlhahlobo ea Doppler ea Phallo ea Mobala:

• Ka litšoantšo tse fapaneng tsa systolic ve phaello e nepahetseng le litlhophiso tsa Nyquist e lokela ho hlahlojoa le.

• Ho lekola ho teba ha MR ka setšoantšo se le seng ho ka etsa ka phoso hore MR a bonahale a le matla ho feta kamoo a hlileng a leng kateng.

• Regurgitation Fraction (RF) Tekanyo:

• RF, PISA, Simpson volumetric le/kapa mekhoa ea Doppler e lekanyang.

• Ho lekanya RF ka mekhoa e mengata, e eketsa ho tšepahala ha tlhahlobo.

• Vena Contracta (VC) Bophara, Bophahamo ba Regurgitant (RVol) le Sebaka se Atlehang sa Regurgitant Orifice (ERO):

• Litekanyo tsena li ka nkoa, empa e fapana ho itšetlehile ka boholo ba mokuli.

• Litekanyetso tse nepahetseng tsa lintja ha li so tsejoe ka botlalo..

• Left Ventricle (LV) le Left Atrium (LA) Katoloso:

• Diastolic ka hare ho ventricular ka ho le letšehali (LVIDdN)> 1.9 be

• Karolelano ea motso oa atrium / aortic ka ho le letšehali (LA: Ao) > 2.0 be

• Liphetoho tsena li etsahala ka lebaka la MRI ke liphetoho tsa bobeli ve ho sa foleng ha lefu lena ve phekolo e sebelisitsoeng Ho ipapisitse le.

• Li-Indices tsa Mosebetsi oa Systolic:

• Karolo e ka ho le letšehali ea ventricular ejection (LVEF) <50% be

• Left ventricular end-diastolic bophara (LVIDsN)> 1.0 be

• Mekhahlelo ena e ka ba sesupo sa hore monyetla oa ho fokotsa MR o fokola.

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Mitral Functional Anatomy le Kamano ea Eona le Katleho

• Mitral valve anatomy e sebetsang, ka mokhoa oa TEER ke e 'ngoe ea lintlha tsa bohlokoa ka ho fetisisa tsa katleho le liphello.

• Litekanyo tsa lisebelisoa tsa ntja tse fumanehang E entsoe ka 14 mm, 16 mm le 18 mm.

• Setšoantšo sa Apical inflow-outflow echocardiographic, The anterior-posterior (AP) mitral annulus bophara bohareng ba systole e pakeng tsa 14-20 mm. E kgothaletswa ho ba le.

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Tlhahlobo ea ho Qetela bakeng sa Tokiso ea Edge-to-Edge

• Sebopeho sa anatomical se sebetsang se lokela ho hlahlojoa ka transesophageal echocardiography (TEE) pele ho ts'ebetso..

• TEE e bontša ka ho hlaka haholoanyane boholo, sebōpeho le ho tšoaneleha ha valve ea mitral bakeng sa mokhoa ona.

1. Ke Lintja Life Tse Loketseng Bakeng sa TEER?

• Lintja ka mekhahlelo ea ACVIM B2 le C ke bonkgetheng ba loketseng ka ho fetisisa.

• Lintja tse Mothating oa D ve lintja tse nang le atrial fibrillation (AF)ha ba tšoanelehe bakeng sa TEER.

2. Mehato ea ho Lekola Botebo ba MR

• Litekanyetso tse kang holosystolic coloring flow jets, regurgitation fraction (RF), vena contracta width le regurgitation volume (RVol) li sebelisoa.

• Ho e-na le setšoantšo se le seng, tlhahlobo ka ho sebelisa mekhoa e mengata kgothaletswa.

3. Tlhahlobo ea Sebopeho sa Anatomical se Sebetsang

• Ho lintja tse nang le sebopeho se nepahetseng sa anatomical (sehlopha se setala) sekhahla sa katleho ea ts'ebetso se phahame.

• Lintja tsa 'mele o itekanetseng (mokhahlelo o mosehla) e ka rua molemo ts'ebetsong, empa likotsi li kholoanyane.

• Lintja tse nang le sebopeho se sa lokang sa anatomical (sehlopha se khubelu) Ha baa tšoaneleha bakeng sa TEER.

4. Tlhahlobo ea Transesophageal Echocardiography (TEE).

• TEE, ke sesebelisoa sa bohlokoahali mokhahlelong oa ho qetela oa tlhahlobo le oa ho etsa liqeto.

• TEE, e fana ka tlhahlobo e nepahetseng ea morphology, boholo le sebopeho sa valve ea mitral.

Ts'ebetsong ena, khetho e nepahetseng ea bakuli, sebopeho se sebetsang sa anatomical ve tlhahlobo ea pele ho ts'ebetso ke lintlha tsa motheo tse amang katleho ka ho toba. Ho etsa tlhahlobo e nepahetseng, e eketsa monyetla oa hore mokhoa ona o atlehe le boleng ba bophelo ba mokuli.

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

Mokhoa oa TEER ho lintja, anesthesia e akaretsang tlase, thoracotomy e nyane ve mokhoa oa transapical cardiac Ntja e tšoareloa sebakeng se sireletsehileng nakong ea ts'ebetso. boemong bo nepahetseng ba lateral decubitus (ho robala ka lehlakore le letona).

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Ho Kena ka Ho Buoa

1. Boikemisetso ba Sebaka sa Intercostal:

• Sebaka se nepahetseng sa intercostal hangata Sebaka sa bo7 sa intercostal le sebaka sena setšoantšo sa lateral fluoroscopic ve transthoracic echocardiography (TTE) e netefatsoa ka ho sebelisoa.

2. Thoracotomy:

• Sekhahla sa thoracotomy ea 3-4 cm, e entsoe feela mokokotlo (karolo e ka holimo) ea sternum.

3. Ho bula Pericardium:

• The pericardium e bulehile le sutured ho sehiloeng ho phahama ha sekhahla sa pelo e fanoe.

4. Ho Khetha Sebaka sa ho Hlaba Pelo:

• Setšoantšo sa Biplane TEE sa ventricle e letšehali le valve ea mitral Sebaka sa ho phunya ha pelo se khethoa ke khatello ea ka ntle ea pelo nakong ea

• Phallo-ntle ve ka maikutlo a commissural Sebaka se pota-potileng sefofane sa mitral valve se nkoa e le sebaka se nepahetseng sa ho phunya.

5. Matrix Stitch ho Heart Hole:

• Ka khoele ea 4-0 polypropylene tse pedi pledget e matlafalitsoeng ho roka matrix, e behiloe sebakeng se nepahetseng sa ho phunya le ho tiisoa ka tsamaiso ea tourniquet.

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Ho shebella le ho shebella li-angles

• Tlhaloso ea Fluoroscopic:

• Fluoroscopic angle, hangata 10 ° cranial ve 0 ° ho isa ho 10 ° e letšehali e ka pele e oblique e behiloe joalo ka.

• Ho ea ka pono ea mokuli, lehlakoreng lena 90 ho isa ho 100 °.

• Ho etsa litšoantšo tsa Transesophageal Echocardiography (TEE).:

• Pono ea li-bi-planar ka lifofane tsa commissural le inflow-outflow fumanoa.

• Mitral valve hape mahlakore a mararo (3D) ka sefahleho (sefahleho se ka pele) setshoantsho se ya lekolwa.

• Hangata aorta e behiloe sebakeng sa hora ea 9, kahoo ho etsa bonnete ba hore mochine o tsamaisana ka mokhoa o lumellanang pakeng tsa TEE le litšoantšo tsa fluoroscopic.

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Anticoagulation

• Tsamaiso ea Heparin Bolus:

• Pele o kena ka pelong, ka methapo 50 U/kg ea heparin E o fuoa.

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Tekanyo ea V-Clamp le ho Bea

Litekanyo tsa V-Clamp:

• 14mm, 16mm le 18mm Ho na le li-V-Clamp tse tharo tse fumanehang.

• V-Clamp size, Anterior-posterior (AP) bophara ba mitral valve bohareng ba systole ho pono ea TEE ea phallo e tsoang kantle.'me boleng bona bo khethoa ho latela 1-2 mm e tlosoa.

Ho bula Lesoba la Pelo le Boitokisetso ba Tsela ea ho Kena:

• Catheter e nang le nale ea 18 G pelo e hlajoa ka.

• 0.035" 50 cm J-tip guidewire, e fetisoa ka catheter ebe e romeloa ventricle e letšehali.

• Catheter e tlosoa le holim'a terata e tataisang Selelekela sa 14F se tsoetse pele ka har'a ventricle e letšehali..

Tsela ea Mitral Valve:

• terata e nang le ntlha e J-tipped le dilator, e nang le tataiso e khethehileng ea mitral passage e nang le ntlha e bonolo ea baskete ea nitinol e fetotsoe.

• Tataiso, ka thuso ea TEE e fetisetsoa morao ka valve ea mitral 'me sheath ea ho fihlella e tsoetse pele ho atrium e letšehali.

V-Clamp Placement:

• Lisebelisoa tsa kabo ea V-Clampe fetisetsoa ho atrium e letšehali ka sheath ea ho fihlella.

• Ho sebelisa matsoho a V-Clamp, TEE le fluoroscopy medial-lateral, anterior-posterior (AP) le ho potoloha e behiloe boemong.

Ho Tšoara Leaflet ea Mitral Valve:

• Matsoho a tlase, e fetisoa ka valve ea mitral ebe e kenngoa tlas'a lipampitšana.

• Joale, matsoho a hodimo a theoleloa fatshe ho tshwara dipampitshana mme V-Clamp e kwetswe.

• Ho tšoaroa lipampitšana, E netefalitsoe ke TEE le fluoroscopy eaba V-Clamp liloko.

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Taolo le Tekolo

• Netefatso ea Leaflet Capture:

• Likarolo tse sa hatelletsoeng (mahala) tsa lipampitšana tse ka pele le tse ka morao li lekanngoa le bolelele ba leqephe le hapiloeng le fetang 4 mm e netefatsoa ha ho hlokahala.

• Bolelele ba pampitšana, e tlositsoe ho bolelele bo lekantsoeng pele tshwaro e nepahetseng e netefaditswe.

• Tšebeliso ea Bobeli ea V-Clamp:

• Maemong a mang, V-Clamp ea bobeli e ka sebelisoa ho lokisa MR ea setseng.

• V-Clamp ea Bobeli, e behiloe haufi haholo le sesebelisoa sa pele sa clamping ’me ho lateloa mokhoa o tšoanang.

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Mokhoa oa TEER ho lintja ho phekola degenerative mitral regurgitation (DMR) e sebelisoa mehleng ea kajeno, e sa hlaseleng ke mokhoa. Mokhoa ona:

• Mini thoracotomy ve mokhoa oa transapical cardiac e etsoa ka.

• TEE le fluoroscopy e tsamaisoa ka.

• Ho beoa ka nepo ha sesebelisoa sa V-Clamp le ho hapa lipampitšana ka katlehoe etsa qeto ea katleho ea ts'ebetso.

• V-Clamp ea bobeli, e ka sebelisoa bakeng sa khalemelo e eketsehileng.

• Anticoagulation le heparin, e thibela ho thehoa ha lesela nakong ea ts'ebetso.

Mokhoa ona, ho lelefatsa nako ea bophelo ea lintja tse nang le lefu la degenerative mitral valve ve ntlafatsa boleng ba bophelo e na le monyetla o moholo oa ho.

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Lingoliloeng tse ling tseo U ka li Thahasellang

• Kalafo ea Pulmonary Stenosis
• Mokhoa oa hau oa tlhahlobo ea lefu la pelo
• Ho koaloa ha Patent Ductus Arteriosus (PDA)
• Transesophageal Echocardiography (TEE)
• Myxomatous Mitral Valve Disease (MMVD)

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"Motho ea nang le setso ke motho ea sa khotsofaleng ka boeena feela."

Andre Gide

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