自膨式带瓣膜主动脉瓣支架对冠脉影响的体外研究  

Coronary flow obstruction in percutaneous aortic valve replacement using self-expandable valved stent： an in vitro study

作　　者：周永新[1] 王永武[1] 梅运清[1] 邵杰[1] 蔡建志[1] 孙林[1] 李刚[1] 

机构地区：[1]同济大学附属同济医院胸心外科,上海200065

出　　处：《中华医学杂志》2009年第20期1435-1437,共3页National Medical Journal of China

摘　　要：目的探讨自膨式带瓣膜主动脉瓣支架（瓣膜支架）行体外原位主动脉瓣置换后对冠状动脉的影响。方法采用12只离体小香猪的升主动脉，经冠脉流量测试系统测得基础的冠脉流量（基础流量）、瓣膜支架植入后的冠脉流量（保留瓣膜组）及去除正常瓣膜后再次植入支架的冠脉流量（去除瓣膜组），并结合内窥镜检查及解剖观察支架及冠脉开口的情况。结果保留瓣膜组左冠流量[（8．07±4．19）ml／s]较基础流量[（11．44＋1．27）ml／／8]明显较少（P〈0．05），右冠流量[（7．07±1．38）ml／8]虽有所减少，但差异无统计学意义（P〉0．05）。去除瓣膜组左右冠脉流量[（10．66±2．01）ml／s、（7．22±1．17）ml／s]较基础流量[（11．44±1．27）ml／s、（7．63±1．01）ml／s]有所减少，但差异均无统计学意义（均P〉0．05），左冠流量去除瓣膜组较保留瓣膜组明显改善增加了32．09％（P〈0．05）。解剖发现左冠开口相对较低。内窥镜检查发现，在保留瓣膜组正常主动脉瓣瓣叶被支架压向侧壁，造成左冠开口完全阻塞3只，部分阻塞4只，右冠开口部分阻塞3只。两组中共见5只瓣膜支架的瓣脚影响冠脉开口，使其部分阻塞，其中左冠4只，右冠1只。结论自膨式瓣膜支架行原位主动脉瓣植入后，被压向侧壁的瓣叶易使左冠开口阻塞。同时瓣膜支架的瓣脚有时也会部分影响冠脉流量。Objective To study the effects of self-expandable and orthotopically implanted pereutaneous aortic valved stent on coronary artery flow in vitro. Methods Self-expandable valved stent was developed with nitinol stent and bovine pericardium. The ascending aorta of Chinese miniswine hearts was cut proximal to the brachiocephalic trunk. The right and left main coronary arteries were dissected. In vitro coronary flow tests were performed. Firstly, baseline coronary flow with the native aortic valve was measured （n = 12）. Secondly, the valved stent was deployed orthotopically. The commissures of prosthesis were positioned randomly. Through an endoscope, the effects of valved stent and native valve on coronary ostium were obtained and coronary flow measurements repeated （valve preservation group, n = 12）. Then the distance from coronary ostium to native leaflet free edge was measured. Native leaflets were removed before similar valved stent deployment. Coronary flow measurements and endoscopic inspections were repeated postimplantation （valve removal group, n = 12）. Results In valve preservation group, valved stent implantation resulted in a significant decrease in left coronary flow [ （ 8.07 ± 4. 19 ） ml/s vs （ 11.44 ± 1.27 ） ml/s, P 〈 0. 05） ]. The obstruction was due to native leaflets sandwiched between the stent and aortic waft. The left ostia were obstructed totally in 3 and partially in 4. There was no significant decrease in the right coronary flow [ （7. 07 ± 1.38） ml/s vs（7. 63 ±1. 01 ） ml/s, P 〈0. 05]. The right ostia were obstructed partialy in 3. In valve removal group, the left and right coronary flow [ （ 10. 66 ± 2. 01 ） ml/s, （7.22 ± 1.17 ） ml/s ] were observed after valved stent placement, there are no significant decrease compared with baseline coronary flow [ （ 11.44 ± 1.27 ） ml/s, （7. 63 ± 1.01 ） ml/s, P 〉 0.05 ]. The left coronary flow was significantly improved 32. 09% compared with valve preservation group （ P 〈 0. 05 ）, the distance

关 键 词：主动脉瓣 支架 心脏导管插入术 

分 类 号：R686[医药卫生—骨科学]