绵羊带支架自体肺动脉瓣置换二尖瓣的实验研究  

Experimental Research on Sheep Mitral Valves Replacement with Stented-pulmonary Autograft

作　　者：安国营[1,2] 王助衡[3] 张洪宇[2] 李温斌[1] 宋士秋[1] 周子凡[1] 郭海平[1] 乔衍礼[2] 张健群[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029 [2]济宁医学院附属医院心脏外科,山东济宁272029 [3]北京市大兴区人民医院心胸外科,北京102600

出　　处：《中国胸心血管外科临床杂志》2010年第3期215-218,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金资助项目(30371412/C03030304)~~

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±6.0kg。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6h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6h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±1.28mmHgvs.10.98±0.98mmHg,t=1.670,P=0.110)和E(1.72±0.09m/svs.1.65±0.07m/s,t=1.680,P=0.110)与对照组比较差异无统计学意义,EOA(2.23±0.09cm2vs.2.39±0.08cm2,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。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 feasibl

关 键 词：绵羊 二尖瓣病变 自体肺动脉瓣 

分 类 号：R654.2[医药卫生—外科学]