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 绵羊带支架自体肺动脉瓣置换二尖瓣的实验研究()

《中国胸心血管外科临床杂志》[ISSN:1007-4848/CN:51-1492/R]

期数:
2010年第17卷第3期
页码:
215-218
栏目:
基础研究论著
出版日期:
2010-06-25

文章信息/Info

Title:
 Experimental Research on Sheep Mitral Valves Replacement with Stentedpulmonary Autograft
文章编号:
1007-4848（2010）03-0215-04
作者:
 安国营  王助衡 张洪宇 等
 1.首都医科大学附属北京安贞医院 心脏外科，北京100029; 2. 北京市大兴区人民医院心胸外科，北京 102600； 3.济宁医学院附属医院 心脏外科，山东济宁 272029
Author(s):
 AN Guo-ying;  WANG Zhu-heng;  ZHANG Hong-yu; et  al .
 1.Department of Cardiac Surgery, the Affiliated Anzhen Hospital, Capital University of Medical Science, Beijing 100029, P.R. China; 2.Department of Cardiothoracic Surgery, the People’s Hospital of Daxing, Beijing 102600， P.R. China; 3.Department of Cardiac Surgery, the Affiliated Hospital, Jining Medical College, Jining 272029, Shandong, P.R. China
关键词:
 ; 绵羊;  二尖瓣病变;  自体肺动脉瓣
Keywords:
 ; Sheep;  Mitral valve disease;  Stentedpulmonary autograft valve
分类号:
R654.2
DOI:
-
文献标识码:
A
摘要:
 目的 探讨应用带支架自体肺动脉瓣置换二尖瓣的手术方法及可行性，以寻求较理想的治疗二尖瓣病变的手术方案。 方法 自2006年8月至2007年10月北京安贞医院 心脏外科共完成10只绵羊带支架自体肺动脉瓣置换二尖瓣手术。20只绵羊年龄1岁左右，均为雄性，体重50.0±6.0 kg。采用抽签法随机将20只绵羊分为两组，实验组：10只，行RossⅡ型手术，将肺动脉瓣缝合到支架上，将带支架的自体肺动脉瓣移植到二尖瓣位，然后重建右心室流出道；对照组：10只，行常规生物瓣二尖瓣置换术。于术后6 h行超声心动图检查，测量二尖瓣有效瓣口面积（EOA）、二尖瓣口峰值血流速度（E）、二尖瓣峰值跨瓣压差（PPG）、反流程度、左心室舒张期末内径（LVEDD）及射血分数（EF）等。 结果 术后实验组绵羊死亡1只，死于低心排血量综合征；对照组绵羊术中1只死于大出血;其余18只绵羊均生存。实验组绵羊术后6 h心脏超声心动图提示：心脏瓣膜固定良好，瓣叶回声清晰，无瓣周漏;二尖瓣无狭窄及反流; 肺动脉瓣中度反流1只，轻度反流2只。实验组PPG(11.86±1.28 mm Hg vs. 10.98±0.98 mm Hg, t=1.670,P=0.110)和E（1.72±0.09 m/s vs. 1.65±0.07 m/s, t=1.680, P=0.110）与对照组比较差异无统计学意义，EOA（2.23±0.09 cm2 vs. 2.39±0.08 cm2, t=4.240,P=0.001）小于对照组。 结论 带支架自体肺动脉瓣置入绵羊二尖瓣位，急性实验结果满意，功能良好，手术方案可行。
Abstract:
 Objective To investigate the feasibility and effect of stentedpulmonary autograft replacement and find out the best way to treat mitral valve diseases. Methods From August 2006 to October 2007, 20 male sheep at the age of about 1 year old underwent mitral valves replacement operation in Anzhen Hospital. Weight of these sheep was 50.0±6.0 kg. They were randomly divided into two groups. Ten sheep in the experimental group underwent RossⅡsurgery in which we first sutured pulmonary valve onto a pulmonary valve stent, transferred the valve to the mitral valve annulus and then reestablished the outflow tract of the right ventricle. The other 10 sheep in the control group underwent bioprosthetic valve replacement routinely. Ultrasonic cardiogram (UCG) was employed 6 hour after operation to measure the effective orifice area (EOA) of the mitral valve, mitral peak velocity of early filling, the peak pressure gradient (PPG), the extent of regurgitation, left ventricular enddiastolic dimension (LVEDD) and ejection fraction (EF). Results One sheep in the experimental group died of low cardiac output syndrome; one in the control group died of unmanageable bleeding during operation, and the others all survived. Six hours after operation, UCG of the experimental group showed that the heart valves were well fixed, valve echo was clear, and there was no perivalvular leakage or mitral valve stricture or regurgitation, but moderate pulmonary valve regurgitation occurred in 1 case and mild in 2. There was no significant difference between the two groups in PPG (11.86±1.28 mm Hg vs. 10.98±0.98 mm Hg,t= 1.670,P=0.110) and the mitral peak velocity of early filling (1.72±0.09 m/s vs. 1.65±0.07 m/s, t=1.680,P=0.110). However, EOA of the experimental group was smaller than the control group (2.23±0.09 cm2 vs. 2.39±0.08 cm2, t= 4.240,P= 0.001). Conclusion The experimental result of sheep mitral valves replacement with stentedpulmonary autograft is satisfying. The new mitral valves work well and the surgery method is feasible.

参考文献/References

备注/Memo

备注/Memo:
更新日期/Last Update: 2010-07-06