肺动脉带瓣支架植入术实验研究  

Experimental study on implanted pulmonary valve stent

作　　者：李博宁[1] 张智伟[1] 丁以群[1] 王树水[1] 王晟[1] 

机构地区：[1]广东省人民医院广东省心血管病研究所,广州510100

出　　处：《岭南心血管病杂志》2008年第4期270-273,共4页South China Journal of Cardiovascular Diseases

基　　金："十一五"国家科技支撑计划(编号:2007BA105B03);广东省科技计划项目(项目编号:2006B12901003)

摘　　要：目的把猪心包为瓣膜材料的带瓣肺动脉瓣膜支架植入动物体内,探讨该技术可行性。方法猪心包经过提取、打磨、浸泡等处理后,制作成三瓣叶形状,用聚丙烯线固定于自膨胀镍钛支架内。在0.6%戊二醛浸泡36h后保存于60%的乙醇中。打开胸腔及心包,暴露心脏,穿刺右心室前壁,在超声监测下,成功对7头羊和1头猪植入肺动脉带瓣支架。结果全部植入支架的动物未出现并发症。术前及术后即刻、24h、1个月和2个月行心脏超声,术后第2和第3个月行造影检查,支架内瓣膜开放良好,无反流。带瓣支架置入前后右心室压力、肺动脉压力,未出现明显的血流动力学变化,1例羊术后2个月于肺动脉到右心室连续拉管测得12mmHg(1mmHg=0.133kPa)压差,该例肺动脉带瓣支架植入位置偏低,处于右心室流出道位置,其他植入位置正常。术后第2个月行大体及光镜观察发现固有瓣膜因被支架压靠在肺动脉壁内而被废用,支架的另一端处于右心室流出道,支架内瓣膜未见钙化灶,周围组织无炎症反应,少量上皮组织爬行,肺、肝、脾、肾等重要器官均无血栓现象。电镜观察示周围组织细胞形态结构正常,支架内瓣膜纤维组织形态结构正常。结论以猪心包为瓣膜材料的带瓣肺动脉支架在动物体内应用安全有效。Objectives To study the feasibility and safety of implantation of pig perlcardium-made pulmonary valve stent to animals. Methods After being extracted, burnished and soaked, pig percardium was made into tricuspid like, stitched into a self-expandable alloy stent consisting of nickle and Ti with polypropylene thread, soaked in Glutaral for 36 hours and preserved in 60% alcohol. Thoracic cavity and pericardium were opened, the heart was disclosed, pulmonary valve stents were implanted into sheeps or pig through right ventricular anterior wall under the direction of echocardiography. Results Valves in the stent worked very well, no backstreaming was found both in echocardiography immediately after operation or 3-month following and in angiography at 2^nd month or 3^rd month. There were no significant difference in right ventricular pressure and in pulmonary arterial pressure before and after valve implantation, besides, a mild systolic pressure gradient of 12 mm Hg through the stent between the right ventricle and the pulmonary artery was seen in a sheep in which stent with valve was located in right ventricular outflow. Gross and microscope showed that the native pulmonary valve was nonfunctional because it was stuck between the pulmonary wall and the stent and the other extremity of the stent were embedded into the right ventricular outflow. Visible calcification, surrounding tissue inflammatory reaction and embolization in liver, kidney and lung, were not found in stent valves. After 6 months, scanning electron microscope showed normal surrounding tissue cells and stent fibrous valve. Conclusions Stent with pig pericardium-made valve implanted into animals is effective and safe.

关 键 词：肺动脉瓣反流 心脏外科手术 带瓣支架 动物试验 

分 类 号：R654.2[医药卫生—外科学] R540.46[医药卫生—临床医学]