经皮“瓣上瓣”支架植入治疗急性主动脉瓣关闭不全的应用解剖  

Applied anatomy of percutaneous "valve-above-valve" stent implantation to treat the acute aortic insufficiency

作　　者：刘洁[1] 徐佰达[1] 凌秋洋 王霄[1] 安冬梅[1] 曹丽[1] 白元[2] 宗刚军[1] 

机构地区：[1]中国人民解放军第101医院心血管内科,江苏无锡214044 [2]第二军医大学附属长海医院心血管内科,上海200433

出　　处：《中国临床解剖学杂志》2016年第5期481-485,共5页Chinese Journal of Clinical Anatomy

基　　金：国家自然科学基金面上项目(81371657)

摘　　要：目的为经皮"瓣上瓣"支架植入治疗急性主动脉瓣膜关闭不全提供相关应用解剖。方法解剖5例外形大小正常的成年人心脏和升主动脉的标本;回顾性分析178例升主动脉CTA病人影像资料,其中男性131例,女性47例,以及85例主动脉瓣上造影(DSA)病人资料,其中男性45例,女性40例,测量不同位置升主动脉的内径及长度。结果根据升主动脉CTA测得D1、D2、L1、L2分别为(30.5±2.3)、(25.5±1.8)、(36.5±3.6)、(31.2±4.1)mm,经体表面积标准化后得出的SD1、SD2、SL1、SL2分别为(17.1±1.2)、(14.2±0.9)、(21.4±1.1)、(17.8±1.3)mm;根据升主动脉DSA测量得出的D1’、D2’、L1’、L2’分别为(28.7±2.8)、(24.4±2.1)、(34.3±2.9)、(29.4±3.6)mm,经体表面积标准化后得出SD1’、SD2’、SL1’、SL2’分别为(16.0±1.4)、(13.5±1.2)、(19.7±1.6)、(16.7±2.0)mm。结论经皮主动脉"瓣上瓣"支架具有成功的动物实验研究背景,可作为一种新技术用于临床,其瓣膜支架的大小和形状的设计应根据升主动脉段的内径和长度来选择。Objective To provide the anatomical basis for percutaneous ＂valve-above-valve＂ stent implantation in the treatment of the acute aortic insufficiency. Methods The normal adult hearts and the ascending aorta in 5 specimens with the same shape and size were dissected, the aortic CTA data of 178 cases were retrospectively analyzed, among which 131 cases were male, 47 cases female; and the aortic angiography data of 85 cases were retrospectively analyzed, among which 45 cases were male, 40 cases were female. The inner diameter and length of the ascending aorta in different location were measured. Results The inner diameter at the opening of the brachiocephalic trunk measuredby aorta CTA was （30.5±2.3）mm, the inner diameter at the opening of the coronary artery was （25.5±1.8）mm, and the distance from the midpoint to the two openings was （36.5 ± 36.5） mm and （31.2 ± 4.1） mm, respectively. After standardization of the body surface area, the values were respectively（17.1 ± 1.2）,（14.2 ± 0.9）,（21.4 ± 1.1）and（17.8 ± 1.3）mm;the above mentioned values measured in the same way by DSA were（28.7±2.8）,（24.4±2.1）,（34.3±2.9）and（29.4±3.6） mm, respectively. After standardization of the body surface area, the values were（16.0 ± 1.4）,（13.5 ± 1.2）, （19.7 ± 1.6）and（16.7 ± 2.0）mm, respectively. Conclusion There has been a successful animal experiment research background in the percutaneous＂valve-above-valve＂stent, which can be used for clinical purposes as a new technology. The size and shape of the ＂valve-above-valve＂ stent should be designed by the inner diameter and the length of the ascending aorta.

关 键 词：心脏 “瓣上瓣”支架 经皮 主动脉瓣 应用解剖 

分 类 号：R322.11[医药卫生—人体解剖和组织胚胎学]