I-TEER Mitral Valve Repair (V-Clamp)

Isikhathi sokufunda esilinganiselwe: 10 iminithi

Incazelo kanye Nomlando

Ukulungiswa kwevalvu ye-mitral enqenqemeni ukuya konqenqemeni Lo mqondo wasungulwa udokotela ohlinza inhliziyo Ottavio Alfieri ngo, ukulungisa i-prolapse (prolapse) yepheshana langaphambili le-mitral valve Kuye kwahlongozwa njengesixazululo sokuhlinzwa kulokhu. Kule teknoloji, ipheshana eliqhumayo lithungelwa epheshaneni elibhekene nalo Ivalvu ye-mitral enama-orifice amabili (double-orifice) iyakhiwa.

Ukulandela le nqubo yokulungisa ngempumelelo yokuhlinzwa, ukulungiswa kwevalvu ye-mitral edge-to-edge transcatheter (TEER) kwathuthukiswa ubuchwepheshe. Le nqubo, indlela engahlaseli isibe indlela yokwelapha evamile ezigulini ezingabantu.

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Sebenzisa Kubantu

Inqubo ye-TEER kubantu, Idivayisi ye-MitraClip kwenziwa ngokusebenzisa.

• I-EVEREST yocwaningo lokungenzekaLolu ucwaningo lokuqala olwenziwe ukuhlola ukusebenza kahle nokuphepha kwedivayisi ye-MitraClip.

• I-EVEREST II kanye ne-COAPT Izifundo ezimbili ezinkulu ezinesihloko esithi, ifakazele ukusebenza kwe-TEER ekwelapheni i-mitral regurgitation (MR) enzima futhi iholele ekwamukelweni kwayo kabanzi..

• I-TEER kubantu ayisekho Inketho yokwelashwa ephephile nesebenzayo yokubuyisela kabusha kwe-mitral okunzima isetshenziswa kabanzi njenge.

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Intuthuko ku-Veterinary Cardiology

Impumelelo efinyelelwe kubantu iholele ekusungulweni komshini ofanayo ekwelashweni kwezilwane. Le divayisi yakhelwe ngokukhethekile izinja. I-Canine Mitral V-Clamp idivayisi.

I-Canine Mitral V-Clamp Idivayisi

• Le divayisi, Yakhelwe ukwelapha isifo esiwohlokayo se-mitral valve (DMVD) ezinjeni.

• Okokuqala, Ezinjeni eziyisi-1 ezinesigaba B8 esiwohlokile isifo se-mitral valve Ocwaningweni lokuqala, ukusebenza nokusebenza kwedivayisi kubonisiwe.

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Izifundo Zomtholampilo

• Ezinjeni ezine-mitral regurgitation enzima (MR) Isilingo esingenzeka sedivayisi ye-V-Clamp sekwenzekile.

• Inhloso yalolu cwaningo bekuwukuhlola ukuthi idivayisi iphephe futhi isebenza kahle kangakanani ezinjeni.

• Ukulungisa i-Transcatheter edge-to-edge mitral valve (TEER), Okokuqala inqubo eyenziwa kubantufuthi Idivayisi ye-MitraClip Isetshenziswa kabanzi ukwelapha i-mitral regurgitation (MR) enamandla kakhulu

• Ezokwelapha zezilwane, Idivayisi yeCanine Mitral V-Clamp, ngokufanayo ezinjeni I-Degenerated mitral valve disease (DMVD) yakhelwe ukwelapha.

• Izifundo zokuqala, ukusetshenziswa kwalolu cingo ezinjeni ikhombisa ukuthi iyasebenza futhi iphephile.

• Ukusebenza okubanzi nokusebenza kahle kocingo, Ucwaningo olungenzeka ezinjeni ezine-mitral regurgitation enamandla ihlolwa nge.

Lezi zinguquko ku-cardiology yezilwane ukuvela kwezinketho ezintsha, ezingezona ezihlaselayo zokwelapha isifo esiwohlokayo se-mitral valve Linikeza.

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Imibandela Yokufaneleka Yokuqalisa

I-Degenerative mitral regurgitation (DMR) izinja ezizobhekana nokungenelela ngenxa I-American Society of Echocardiography (ASE) criteria ye-mitral regurgitation (MR) enzima kubantu kumele ihlangabezane nemibandela eguquliwe.

• Izinja ezisesiteji se-ACVIM B2 noma Cuthathwa njengomuntu ozongenela ukungenelela kwe-mitral.

• Isigaba sakamuva D noma izinja ezine-atrial fibrillation (AF), ukungenelela kwe-mitral abathathwa njengabafanelekile.

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Imibandela Yokuxilonga Ye-Mitral Regurgitation Enzima (MR)

Ukuze kutholakale ubunzima buka-MR kumele kuhlolwe imibandela engaphezu kweyodwa. Imibandela esekela u-MR Kuyinto kanje:

• I-Holosystolic, amajethi agelezayo anombala we-eccentric athinta udonga noma ngaphezu kuka-50% wendawo yejethi enemibala emaphakathi

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

• Iphrofayili eqinile ye-holosystolic engunxantathu yokubuyisela kabusha ku-Doppler wave eqhubekayo

• Ingxenyana yokubuyisela kabusha (RF) ≥50% (I-Proximal Isovelocity Surface Area (PISA) ingalinganiswa ngevolumu noma nge-Doppler)

• Ivolumu yokubuyisela kabusha (RVol) ≥1.0 mL/kg

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Izindlela Zokuhlola

• Ukuhlola I-Doppler Yokugeleza Kombala:

• Ngezithombe ezahlukene ze-systolic ve inzuzo efanele kanye nezilungiselelo ze-Nyquist kufanele ihlolwe nge.

• Ukuhlola ubukhali be-MR ngesithombe esisodwa kungenza ngokungalungile uMR abonakale enzima kakhulu kunalokho eyikho ngempela.

• Isilinganiso Sokulinganiswa Kwengxenyana Yokubuyisela (RF).:

• RF, I-PISA, i-Simpson volumetric kanye/noma izindlela ze-Doppler elilinganisekayo.

• Ukulinganisa i-RF ngezindlela eziningi, kwandisa ukwethembeka kokuhlola.

• I-Vena Contracta (VC) Ububanzi, Ivolumu Ephindaphindwayo (i-RVol) kanye Nendawo Esebenzayo Ye-Regurgitant Orifice (ERO):

• Lezi zilinganiso zingabhekwa, kodwa kuyahlukahluka kuye ngobukhulu besiguli.

• Amanani aqondile omkhawulo wezinja awakakanqunywa ngokugcwele..

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

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

• Isilinganiso sempande ye-atrium/aorta yesokunxele (LA:Ao) >2.0 ekubeni

• Lezi zinguquko zenzeka ngenxa ye-MRI izinguquko zesibili ve ukungapheli kwesifo ve ukwelashwa okusetshenzisiwe kuya.

• I-Systolic Function Indices:

• Ingxenye ye-ventricular ejection yesokunxele (LVEF) <50% ekubeni

• Ububanzi be-diastolic ye-ventricular kwesokunxele (LVIDsN) >1.0 ekubeni

• Lezi zimiso zingase zibe inkomba yokuthi amandla okuncipha kwe-MR abuthakathaka.

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I-Mitral Functional Anatomy kanye Nobudlelwano Bayo Nempumelelo

• I-valve ye-mitral i-anatomy esebenzayo, kunqubo ye-TEER ingenye yezinqumo ezibaluleke kakhulu zempumelelo nemiphumela.

• Ubukhulu bemishini yezinja etholakalayo Yakhelwe ngo-14 mm, 16 mm no-18 mm.

• Isithombe se-apical inflow-outflow echocardiographic, Ububanzi be-anterior-posterior (AP) mitral annulus maphakathi ne-systole buphakathi kuka-14-20 mm Kunconywa ukuba ube.

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Ukuhlolwa Kokugcina Kokulungiswa Kwe-Edge-to-Edge

• Isakhiwo se-anatomical esisebenzayo kufanele sihlolwe nge-transesophageal echocardiography (TEE) ngaphambi kwenqubo..

• I-TEE ikhombisa ngokucace kakhudlwana ubukhulu, i-anatomy nokufaneleka kwevalvu ye-mitral ngenqubo.

1. Yiziphi Izinja Ezifanelekela I-TEER?

• Izinja ezigabeni ze-ACVIM B2 no-C yibo abafaneleka kakhulu.

• Izinja Esiteji D ve izinja ezine-atrial fibrillation (AF)abafanelekile amakhandidethi e-TEER.

2. Imibandela Yokuhlola Ubukhulu buka-MR

• Imibandela efana namajethi agelezayo anombala we-holosystolic, ingxenye ye-regurgitation (RF), ububanzi be-vena contracta kanye nevolumu yokuguquguquka (RVol) isetshenziswa.

• Esikhundleni sesithombe esisodwa, ukuhlola kusetshenziswa izindlela eziningi kunconyiwe.

3. Ukuhlolwa Kwesakhiwo Se-anatomical Esisebenzayo

• Ezinjeni ezinesakhiwo esifanele se-anatomical (isigaba esiluhlaza) izinga lempumelelo yenqubo liphezulu.

• Izinja ezinomthethosisekelo olingana ngokumaphakathi (isigaba esiphuzi) ingase izuze kule nqubo, kodwa ubungozi bukhulu.

• Izinja ezinesakhiwo se-anatomical esingafanelekile (isigaba esibomvu) Abawona amakhandidethi afanelekile e-TEER.

4. Ukuhlolwa kwe-Transesophageal Echocardiography (TEE)

• TEE, iyithuluzi elibaluleke kakhulu esigabeni sokugcina sokuhlola nokuthatha izinqumo.

• TEE, inikeza ukuhlolwa okunembile kwe-morphology, ubukhulu kanye nesakhiwo se-valve ye-mitral.

Kule nqubo, ukukhetha okulungile kwesiguli, isakhiwo se-anatomical esisebenzayo ve ukuhlolwa kwangaphambili kwenqubo yizici eziyisisekelo ezithinta impumelelo ngqo. Ukwenza ukuhlola okulungile, kwandisa amathuba okuba inqubo ibe yimpumelelo kanye nezinga lempilo yesiguli.

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

Inqubo ye-TEER ezinjeni, i-anesthesia jikelele ngaphansi, i-thoracotomy encane ve indlela ye-transapical yenhliziyo Inja igcinwe endaweni ephephile phakathi nenqubo. endaweni engakwesokudla ye-decubitus engemuva (elele ngakwesokunene).

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Ukungenelela Ngokuhlinzwa

1. Ukunqunywa kwe-Intercostal Space:

• Indawo ekahle ye-intercostal imvamisa Isikhala se-7 se-intercostal kanye nale ndawo i-lateral fluoroscopic imaging ve i-transthoracic echocardiography (TTE) iqinisekiswa kusetshenziswa .

2. I-Thoracotomy:

• I-intercostal thoracotomy incision engu-3-4 cm, yenziwa nje i-dorsal (ingxenye engenhla) ye-sternum.

3. Ukuvula i-Pericardium:

• I-pericardium ivuliwe futhi waxhunywa ekusikeni ukuphakama kwe-apex yenhliziyo inikezwa.

4. Ukunquma Indawo Yokubhoboza Inhliziyo:

• Isithombe se-Biplane TEE se-ventricle yesokunxele nevalve ye-mitral Indawo yokubhoboza inhliziyo inqunywa ukucindezelwa kwangaphandle kwenhliziyo ngesikhathi

• Ukugeleza kokuphumayo ve emibonweni ye-commissural Indawo ehambisana nendiza ye-mitral valve ibhekwa njengephuzu elifanele lokubhoboza.

5. I-Matrix Stitch ku-Heart Hole:

• Ngentambo ye-polypropylene engu-4-0 ezimbili isibambiso siqiniswe ukuthungwa kwe-matrix, ibekwe endaweni efanele yokubhoboza futhi iqiniswe ngesistimu ye-tourniquet.

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Ukubuka nokubuka ama-engeli

• I-Fluoroscopic Imaging:

• I-engeli ye-Fluoroscopic, ngokuvamile 10° cranial ve 0° kuya ku-10° kwesokunxele etshekile ngaphambili isethwe njenge.

• Ngokombono wesiguli, le engeli 90 ° kuya ku-100 °.

• I-Transesophageal Echocardiography (TEE) Imaging:

• Ukubuka kwe-Bi-planar ezindizeni ze-commissural kanye ne-inflow-outflow etholiwe.

• I-valve ye-mitral nayo ubuso obuthathu (3D) en (ubuso bangaphambili) buhlolwa ngokubukeka kwayo.

• I-aorta ivamise ukusetha endaweni yehora lesi-9, ngaleyo ndlela kuqinisekisa ukunyakaza okuvumelanisiwe kwedivayisi phakathi kwe-TEE nezithombe ze-fluoroscopic.

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I-Anticoagulation

• Ukuphathwa kwe-Heparin Bolus:

• Ngaphambi kokungena enhliziyweni, ngomjovo I-heparin engama-50 U/kg Unikelwe.

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I-V-Clamp Measurement and Placement

Ubukhulu be-V-Clamp:

• 14mm, 16mm kanye 18mm Kukhona osayizi abathathu be-V-Clamp abatholakalayo.

• Usayizi we-V-Clamp, I-anterior-posterior (AP) i-mitral valve diameter maphakathi ne-systole ekubukeni kwe-TEE kokugeleza kokuphumayofuthi leli nani linqunywa ngokusho I-1-2 mm isusiwe.

Ukuvula Imbobo Yenhliziyo Nokulungiselela Indlela Yokungena:

• I-catheter enenaliti engu-18 G inhliziyo ibhobokile.

• 0.035” 50 cm J-tip guidewire, idluliswa nge-catheter bese ithunyelwa ku-ventricle yesokunxele.

• I-catheter iyasuswa bese ingena ocingweni lokuqondisa Isingeniso se-14F sithuthukele ku-ventricle yesokunxele..

I-Mitral Valve Passage:

• Intambo enesihloko esingu-J ne-dilator, enomhlahlandlela okhethekile we-mitral passage nethiphu likabhasikidi elithambile le-nitinol ishintshiwe.

• Umhlahlandlela, ngosizo lwe-TEE idlula i-retrogradely nge-mitral valve futhi umgodla wokufinyelela uthuthukisiwe ungene ku-atrium yangakwesobunxele.

Ukubekwa kwe-V-Clamp:

• Imishini yokusabalalisa ye-V-Clampihanjiswa ku-atrium yangakwesobunxele nge-sheath yokufinyelela.

• Ukusebenzisa izingalo ze-V-Clamp, i-TEE kanye ne-fluoroscopy i-medial-lateral, i-anterior-posterior (AP) kanye ne-rotational isethwe ku-orientation.

Ukuthwebula Ipheshana le-Mitral Valve:

• Izingalo ezingezansi, idluliswa nge-valve ye-mitral futhi ifakwe ngaphansi kwamapheshana.

• Bese, izingalo ezingenhla zehliswa ukuze zibambe amapheshana futhi i-V-Clamp ivaliwe.

• Kubanjwa amapheshana, Kuqinisekiswe yi-TEE kanye ne-fluoroscopy bese Amalokhi e-V-Clamp.

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Ukulawula Nokuhlola

• Ukuqinisekiswa Kokuthwebula Ipheshana:

• Izingxenye ezingacindezelwe (zamahhala) zamapheshana angaphambili nangemuva ayalinganiswa futhi Ubude bepheshana obunjiwe obukhulu kuno-4 mm kuqinisekiswa njengoba kudingeka.

• Ubude bamapheshana, kukhishwe kubude obukalwe ngaphambilini ukuthwebula okulungile kuqinisekisiwe.

• Ukusetshenziswa kwe-V-Clamp okwesibili:

• Kwezinye izimo, I-V-Clamp yesibili ingasetshenziswa ukulungisa uMR osele.

• I-V-Clamp yesibili, ibekwe eduze ngangokunokwenzeka kudivayisi yokuqala yokubopha futhi kulandelwa inqubo efanayo.

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Inqubo ye-TEER ezinjeni ukwelapha i-mitral regurgitation ewohlokayo (DMR) esetshenziselwa isimanje, engahlaseli kuyisu. Le nqubo:

• I-thoracotomy encane ve indlela ye-transapical yenhliziyo yenziwa nge.

• I-TEE kanye ne-fluoroscopy iqondiswe nge.

• Ukubekwa okulungile kwedivayisi ye-V-Clamp kanye nokuthwebula ngempumelelo amapheshanainquma impumelelo yomsebenzi.

• I-V-Clamp yesibili, ingasetshenziselwa ukulungisa okwengeziwe.

• I-Anticoagulation nge-heparin, ivimbela ukwakheka kwehlule phakathi nenqubo.

Le nqubo ukwandisa isikhathi sokuphila kwezinja ezinesifo esiwohlokayo se-mitral valve ve ngcono izinga lempilo inamandla amakhulu we.

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Ezinye Izihloko Ongase Uzithande

• Ukwelashwa kwe-Pulmonary Stenosis
• Inqubo Yakho Yokuhlola I-Cardiology
• Ukuvalwa kwe-Patent Ductus Arteriosus (PDA)
• I-Transesophageal Echocardiography (TEE)
• I-Myxomatous Mitral Valve Disease (MMVD)

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"Umuntu okhuliswe ngamasiko ngumuntu onganeliseki nguye yedwa."

U-Andre Gide

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