I-TEER Mitral Valve Repair (V-Clamp)

Ixesha lokufunda eliqikelelweyo: 10 mzuzu

Ingcaciso neMbali

Ukulungiswa kwevalve ye-mitral kumphetho ukuya kumda Le ngcamango yaveliswa kuqala ngugqirha wotyando lwentliziyo Ottavio Alfieri ngo, ukulungisa iprolapse (prolapse) yephepha elingaphambili levalve ye-mitral Kuye kwacetywa njengesisombululo sotyando kule nto. Kule teknoloji, Iphecana eligobileyo lithungelwa kwiphecana elijongene nalo I-valve ye-mitral ene-orifice ezimbini (i-double-orifice) yenziwe.

Ukulandela le nkqubo yotyando oluyimpumelelo, Ukulungiswa kwevalve ye-mitral edge-to-edge (TEER) ubuchule buphuhlisiwe. Le teknoloji, indlela engeyiyo invasive ibe yindlela yonyango eqhelekileyo kwizigulane zabantu.

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Ukusetyenziswa Ebantwini

Inkqubo ye-TEER ebantwini, Isixhobo seMitraClip yenziwe ngokusebenzisa.

• Uphononongo olunokwenzeka lwe-EVERESTOlu luphononongo lokuqala olwenziwe ukuvavanya ukusebenza kunye nokhuseleko lwesixhobo seMitraClip.

• I-EVEREST II kunye ne-COAPT Izifundo ezibini eziphambili ezinesihloko, ibonakalise ukusebenza kwe-TEER kunyango lwe-mitral regurgitation (MR) enzima kwaye ikhokelele ekwamkelweni kwayo ngokubanzi..

• UKUGQIBELA ebantwini akusekho Ukhetho olukhuselekileyo nolusebenzayo lonyango lwe-mitral regurgitation eqatha isetyenziswa ngokubanzi njenge.

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Ukuqhubela phambili kwi-Veterinary Cardiology

Impumelelo ephunyeziweyo ebantwini yakhokelela ekuphuhlisweni kwesixhobo esifanayo kunyango lwezilwanyana. Esi sixhobo senzelwe izinja ngokukodwa. ICanine Mitral V-Clamp isixhobo.

Canine Mitral V-Clamp Isixhobo

• Esi sixhobo, Iphuhliswe ukunyanga isifo se-mitral valve (DMVD) kwizinja.

• Okokuqala, Kwizinja ezisi-1 ezinenqanaba B8 lesifo se-mitral valve Kuphononongo lokuqala, ukusetyenziswa kunye nokusebenza kwesixhobo kubonisiwe.

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Izifundo zeklinikhi

• Kwizinja ezine-mitral regurgitation enzima (MR) Ulingo olulindelekileyo lokwenzeka kwesixhobo se-V-Clamp iye yazaliseka.

• Injongo yolu phononongo ibikukuvavanya ukuba isixhobo sikhuselekile kwaye sisebenza kangakanani ezinjeni.

• Ukulungiswa kwevalve ye-mitral edge-to-edge (TEER), Okokuqala inkqubo eyenziwa ebantwinikwaye Isixhobo seMitraClip Isetyenziswa ngokubanzi ukunyanga i-mitral regurgitation (MR) eqatha usebenzisa

• Kwiyeza lezilwanyana, Isixhobo seCanine Mitral V-Clamp, ngokufanayo kwizinja isifo se-mitral valve (DMVD) yenzelwe ukunyanga.

• Izifundo zokuqala, ukusetyenziswa kwesi sixhobo ezinjeni ibonisa ukuba iyasebenza kwaye ikhuselekile.

• Ukusebenza ngokubanzi kunye nokusebenza kakuhle kwesixhobo, Uphononongo olulindelekileyo lokwenzeka kwizinja ezine-mitral regurgitation eqatha ivavanywa nge.

Olu phuhliso kwi-cardiology yezilwanyana ukuvela kokhetho olutsha, olungangeneleli kunyango lwesifo se-mitral valve inikeza.

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Iikhrayitheriya zokuLungela ukuQalisa

I-Degenerative mitral regurgitation (DMR) izinja eziya kuba phantsi kokungenelela ngenxa Iikhrayitheriya ze-American Society of Echocardiography (ASE) ze-mitral regurgitation (MR) enzima ebantwini kufuneka ihlangabezane nemigaqo ehlengahlengisiweyo.

• Izinja ezikwinqanaba le-ACVIM B2 okanye Cuthathwa njengomgqatswa wongenelelo ngoncedo lwe-mitral.

• Inqanaba lokugqibela D okanye izinja ezine-atrial fibrillation (AF), ukungenelela kwe-mitral abathathwa njengabafanelekileyo.

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Iikhrayitheriya zokuDinga ukuBuyiselwa kweMitral okuMandundu (MR)

Ukumisela ubungqongqo bukaMnu kufuneka kuvandlakanywe ngaphezu kweekhrayitheriya enye. Iikhrayitheriya ezixhasa u-MR oqatha Oko ngolu hlobo lulandelayo:

• I-Holosystolic, iijethi ezihamba ngemibala eccentric ezichaphazela udonga okanye ngaphezulu kwe-50% yendawo yejethi enemibala ephakathi

• Isantya se-E-wave esiphezulu sokungena kwe-mitral ≥1.0 m/s

• Iprofayile ye-holosystolic ye-triangular regurgitation enzulu kwi-Doppler wave eqhubekayo

• Iqhezu lokubuyisela (RF) ≥50% (I-Proximal Isovelocity Surface Area (PISA) inokulinganiswa ngomthamo okanye ngeDoppler)

• Umthamo wokubuyisela (RVol) ≥1.0 mL / kg

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Iindlela zoVavanyo

• UVavanyo lweDoppler Flow Color:

• Kwimifanekiso eyahlukeneyo ye-systolic ve inzuzo efanelekileyo kunye nezicwangciso zeNyquist kufuneka ivavanywe nge.

• Ukuvavanya ubungqongqo buka-MR ngomfanekiso omnye kunokwenza ngokungachanekanga ukuba uMR abonakale eqatha ngakumbi kunokuba kunjalo.

• I-Fraction Regurgitation (RF) Umlinganiselo:

• RF, I-PISA, i-Simpson volumetric kunye / okanye iindlela zeDoppler inomlinganiselo.

• Ukulinganisa iRF ngeendlela ezininzi, kwandisa ukuthembeka kovavanyo.

• I-Vena Contracta (VC) Ububanzi, iVolume ye-Regurgitant (RVol) kunye ne-Effective Regurgitant Orifice Area (ERO):

• Le milinganiselo inokuthathelwa ingqalelo, kodwa iyahluka ngokuxhomekeke kubungakanani besigulana.

• Awona maxabiso achanekileyo ezinja awakamiselwa ngokupheleleyo..

• I-Ventricle yasekhohlo (LV) kunye ne-Left Atrium (LA) Ukwandiswa:

• I-diastolic yangaphakathi ye-ventricular yasekhohlo (LVIDdN)>1.9 ekubeni

• I-atrium ekhohlo / i-aortic root ratio (LA: Ao) > 2.0 ekubeni

• Olu tshintsho lwenzeka ngenxa ye-MRI lutshintsho lwesibini ve ukunganyangeki kwesi sifo ve unyango olusetyenziswayo kuxhomekeke.

• Iimpawu zeSystolic Function:

• Iqhezu lokukhutshwa kwe-ventricular yasekhohlo (LVEF) <50% ekubeni

• Idayimitha ye-diastolic ye-ventricular yasekhohlo (LVIDsN)>1.0 ekubeni

• Ezi parameters zinokuba luphawu lokuba amandla okunciphisa uMR abuthathaka.

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I-Mitral Functional Anatomy kunye nobudlelwane bayo kwiMpumelelo

• Ivalve yeMitral i-anatomy esebenzayo, kwinkqubo ye-TEER yenye yezona zinto zibalulekileyo zokumisela impumelelo kunye neziphumo.

• Imilinganiselo yezixhobo zenja ezikhoyo Yenziwe kwi-14 mm, i-16 mm kunye ne-18 mm.

• Umfanekiso we-apical inflow-outflow echocardiographic, I-anterior-posterior (AP) mitral annulus diameter phakathi kwe-systole iphakathi kwe-14-20 mm Kucetyiswa ukuba ube nayo.

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UVavanyo lokugqibela loLungiso lwe-Edge-to-Edge

• Isakhiwo se-anatomical esisebenzayo kufuneka sihlolwe nge-echocardiography ye-transesophageal (TEE) ngaphambi kwenkqubo..

• I-TEE ibonisa ngokucacileyo ngakumbi ubungakanani, i-anatomy kunye nokufaneleka kwevalve ye-mitral kwinkqubo.

1. Zeziphi izinja ezifanelekileyo kwi-TEER?

• Izinja kwi-ACVIM B2 kunye ne-C izigaba ngabona baviwa bafanelekileyo.

• Izinja kwiNqanaba D ve izinja ezine-atrial fibrillation (AF)abagqatswa bafanelekileyo kwi-TEER.

2. Iikhrayitheriya zokuHlola uBungqongqo buka-MR

• Iikhrayitheriya ezifana neejethi ezimibalabala ze-holosystolic, i-regurgitation fraction (RF), ububanzi bekhontraktha ye-vena kunye nomthamo we-regurgitation (RVol) ziyasetyenziswa.

• Endaweni yomfanekiso omnye, Uvavanyo kusetyenziswa iindlela ezininzi kucetyiswa.

3. Uvavanyo loLwakhiwo lwe-Anatomical oluSebenzayo

• Kwizinja ezinesakhiwo esifanelekileyo se-anatomical (udidi oluluhlaza) izinga lempumelelo yenkqubo liphezulu.

• Izinja ezinomgaqo-siseko ophakathi (udidi olutyheli) banokuzuza kwinkqubo, kodwa imingcipheko inkulu.

• Izinja ezinesakhiwo esingafanelekanga se-anatomical (udidi olubomvu) Abafanelekanga ukuba ngabagqatswa be-TEER.

4. Uvavanyo lwe-Transesophageal Echocardiography (TEE).

• TEE, sesona sixhobo sibaluleke kakhulu kwinqanaba lokugqibela lovavanyo kunye nelokwenza izigqibo.

• TEE, ibonelela ngovavanyo oluchanekileyo lwe-morphology, ubungakanani kunye nesakhiwo sevalve ye-mitral.

Kule nkqubo, ukhetho oluchanekileyo lwezigulane, isakhiwo se-anatomical esebenzayo ve uvandlakanyo lwangaphambili zizinto ezisisiseko ezichaphazela ngqo impumelelo. Ukwenza uhlolo oluchanekileyo, kwandisa amathuba okuba inkqubo ibe yimpumelelo kunye nomgangatho wobomi bomguli.

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

Inkqubo ye-TEER kwizinja, i-anesthesia jikelele ngaphantsi, ithoracotomy encinci ve indlela ye-transapical cardiac Inja igcinwe kwindawo ekhuselekileyo ngexesha lenkqubo. kwindawo yasekunene decubitus ecaleni (elele ngecala lasekunene).

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Ungenelelo ngotyando

1. Ukumiselwa kwe-Intercostal Space:

• Indawo efanelekileyo ye-intercostal iqhelekile Indawo ye-7 ye-intercostal kunye nale ndawo umfanekiso we-fluoroscopic osecaleni ve i-transthoracic echocardiography (TTE) iqinisekiswa kusetyenziswa .

2. I-Thoracotomy:

• I-3-4 cm ye-intercostal thoracotomy incision, yenziwe nje i-dorsal (inxalenye ephezulu) ye-sternum.

3. Ukuvula iPericardium:

• I-pericardium ivuliwe kwaye ubotshelelwe kwisikali ukuphakama kwinqanaba lentliziyo ibonelelwe.

4. Ukumisela indawo yokugqobhoza kweNtliziyo:

• Umfanekiso we-Biplane TEE we-ventricle yasekhohlo kunye nevalve ye-mitral Indawo yokugqobhoza kwentliziyo imiselwe ngokunyanzeliswa kwangaphandle kwentliziyo ngexesha

• Ukuphuma kokungena ve kwiimbono ze-commissural Indawo ethe ngqo kwinqwelomoya yevalve ye-mitral ithathwa njengeyona ndawo ifanelekileyo yokugqobhoza.

5. I-Matrix Stitch kwi-Heart Hole:

• Nge-4-0 intambo ye-polypropylene Mbini isibambiso somelezwe ukuthungwa kwematrix, ifakwe kwindawo efanelekileyo yokubhoboza kwaye iqiniswe ngenkqubo ye-tourniquet.

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Ukujonga kunye nokuJonga ii-engile

• Umfanekiso weFluoroscopic:

• I-engile yeFluoroscopic, ngokuqhelekileyo 10 ° cranial ve I-0 ° ukuya kwi-10 ° ekhohlo i-oblique yangaphambili ibekwe njenge.

• Ngokwembono yesigulana, le engile 90 ° ukuya kwi-100 °.

• I-Transesophageal Echocardiography (TEE) Umfanekiso:

• Umbono we-Bi-planar kwi-commissural kunye ne-inflow-outflow plan ifunyenwe.

• Ivalve yeMitral nayo ntathu-ntathu (3D) ebusweni (ubuso obungaphambili) buvavanywa ngokubonakala kwayo.

• I-aorta idla ngokusetwa kwindawo yentsimbi ye-9, ngaloo ndlela iqinisekisa intshukumo ehambelanayo yesixhobo phakathi kwe-TEE kunye nemifanekiso ye-fluoroscopic.

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I-Anticoagulation

• Ulawulo lwe-Heparin Bolus:

• Ngaphambi kokungena entliziyweni, ngemithambo 50 U / kg heparin It inikwe.

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I-V-Clamp Measurement kunye nokubekwa

Imilinganiselo ye-V-Clamp:

• 14mm, 16mm kunye ne-18mm Kukho iisayizi ezintathu ze-V-Clamp ezikhoyo.

• Ubungakanani be-V-Clamp, I-anterior-posterior (AP) i-mitral valve diameter kwi-systole ephakathi kwi-imflow-outflow ye-TEE yokujongakwaye eli xabiso limiselwa ngokwe 1-2 mm isusiwe.

Ukuvula umngxuma weNtliziyo kunye noLungiselelo lweNdlela yokuNgena:

• Ikhathetha enenaliti ye-18 G intliziyo ihlatywe nge.

• 0.035” 50 cm J-tip guidewire, idluliswa kwi-catheter kwaye ithunyelwe kwi-ventricle yasekhohlo.

• I-catheter iyasuswa kwaye ungene kwintambo yesikhokhelo Intshayelelo ye-14F ihambele phambili kwi-ventricle yasekhohlo..

IMitral Valve Passage:

• Ucingo olunencam ka-J kunye ne-dilator, kunye nesikhokelo esikhethekileyo se-mitral kunye nencam yebhasikithi ethambileyo ye-nitinol iyatshintshwa.

• Isikhokelo, ngoncedo lwe-TEE idlule ngokubuyisela umva ngevalve ye-mitral kwaye i-sheath yokufikelela ihambele phambili kwi-atrium yasekhohlo.

Ukubekwa kwe-V-Clamp:

• V-Clamp izixhobo zokuhambisaihanjiswa kwi-atrium yasekhohlo nge-sheath yokufikelela.

• Ukusebenzisa iingalo ze-V-Clamp, i-TEE kunye ne-fluoroscopy i-medial-lateral, i-anterior-posterior (AP) kunye nokujikeleza isetwe kuqhelaniso.

Iphecana leMitral Valve liThatha:

• Iingalo ezisezantsi, idluliswa kwi-valve ye-mitral kwaye ifakwe phantsi kwamaphepha.

• Emva koko, iingalo eziphezulu zithotywe ukuze zibambe amaphecana kwaye i-V-Clamp ivaliwe.

• Kubanjwa amaphecana, Iqinisekiswe yi-TEE kunye ne-fluoroscopy ke ngoku Izitshixo ze-V-Clamp.

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Ulawulo noVavanyo

• Iphecana Thatha uQinisekiso:

• Amalungu angaxinzelelwanga (asimahla) amaphecana angaphambili nangasemva ayalinganiswa kwaye Iphecana elithathiweyo linobude obungaphezulu kwe-4 mm kuqinisekiswa njengoko kuyimfuneko.

• Ubude bamaphetshana, kuthatyathwe kubude obulinganiswe ngaphambili ukubamba okuchanekileyo kuqinisekisiwe.

• Ukusetyenziswa kwe-V-Clamp okwesibini:

• Kwezinye iimeko, I-V-Clamp yesibini ingasetyenziselwa ukulungisa uMR oseleyo.

• I-V-Clamp yesibini, ibekwe kufutshane kangangoko kwisixhobo sokuqala sokubambelela kwaye kulandelwa inkqubo efanayo.

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Inkqubo ye-TEER kwizinja ukunyanga i-mitral regurgitation (DMR) esetyenziselwa inamhlanje, non-invasive bubuchule. Le nkqubo:

• Ithoracotomy encinci ve indlela ye-transapical cardiac yenziwa nge.

• I-TEE kunye ne-fluoroscopy iqondiswe nge.

• Ukubekwa ngokuchanekileyo kwesixhobo se-V-Clamp kunye nokubanjwa ngempumelelo kwamaphecanaimisela impumelelo yomsebenzi.

• I-V-Clamp yesibini, ingasetyenziselwa ukulungiswa okongeziweyo.

• I-Anticoagulation kunye ne-heparin, ikhusela ukubunjwa kwehlwili ngexesha lenkqubo.

Le nkqubo ukwandisa ubomi bezinja ezinesifo esiwohlokayo se-mitral valve ve ukuphucula umgangatho wobomi unesakhono esikhulu sokuba.

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Amanye amanqaku onokuthi ube nonomdla kuwo

• Unyango lwe-Pulmonary Stenosis
• Inkqubo yakho yoVavanyo lweCardiology
• Ukuvalwa kwePatent Ductus Arteriosus (PDA)
• I-Transesophageal Echocardiography (TEE)
• I-Myxomatous Mitral Valve Disease (MMVD)

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"Umntu ophucukileyo ngumntu onganelisekanga nguye yedwa."

UAndre Gide

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