完全二尖瓣环上型置入的新型烟囱形机械瓣膜动物实验观察  

Experimental observation on a new chimney shaped mechanical valve completely implanted above mitral annulus in animals

作　　者：唐昊 余咏潮 魏旭峰 王国坤 龚德军 徐志云 Tang Hao;Yu Yongchao;Wei Xufeng;Wang Guokun;Gong Dejun;Xu Zhiyun(Department of Cardiovascular Surgery,Changhai Hospital Affiliated to Naval Medical University,Shanghai 200433,China;China Medical City Animal Center,Taizhou 225300,China)

机构地区：[1]海军军医大学附属长海医院心血管外科,上海200433 [2]中国医药城大动物中心,泰州225300

出　　处：《中华胸心血管外科杂志》2022年第11期673-678,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：上海市科技创新行动"生物医药领域科技支撑项目"(18441902000);上海市科技创新行动"生物医学科技支撑项目"(21S11906000)。

摘　　要：目的为从根本上解决人工瓣膜大小受限、置入技术要求较高、瓣下结构破坏和纤维内皮组织增生造成瓣膜功能障碍等问题。我们研发了一款使用左心室占有率为零的人工瓣膜,瓣架较现有产品适当升高,略呈烟囱形,完全容纳瓣叶在瓣架内部活动,完全环上型手术置入,本研究即使用此瓣膜进行临床前动物实验。方法对7只绵羊在体外循环直视下作了该人工瓣膜的置换术,术后24 h开始用华法林抗凝6个月,术后检测血生化、抗凝及超声心动图指标,180天后处死羊,作尸体解剖,以观察该人工瓣膜是否引起血栓栓塞。观察瓣膜疗效和安全性指标。结果7只羊中有2只在手术后24 h内死亡,5只长期存活,以后在180天处死,处死的羊其人工瓣膜机械性能均良好,人工瓣膜周围及各重要脏器未见有血栓栓塞现象。缝环组织层已完全机化和内皮细胞化,组织层厚度约0.6~1.0 mm。实验动物的二尖瓣瓣叶可自由打开和关闭,表面光滑,未见异常回声。术前及术后6个月间超声心动图示左心室射血分数均正常(0.60~0.70),人工瓣膜跨瓣压差和血流速度结果均表现良好[平均跨瓣压差远远低于5 mmHg(0.665 kPa),平均流速均低于1 m/s],提示人工瓣膜血流动力学性能良好。左心室逆行造影,可见人工瓣膜完全位于左心房,位置良好,启闭正常,造影未见明显瓣周漏等异常情况。血液检验7天内因手术应激各项指标与术前比较多存在异常,至12周及24周,各组动物血常规、肝肾功等血液检验指标与术前未见明显异常。结论完全二尖瓣环上型置入的新型烟囱形机械瓣具有较好的耐磨性、组织相容性、抗血栓性及血流动力学表现。Objective To fundamentally solve the problems of valve dysfunction caused by limited size of artificial valve,high requirements for implantation technology,destruction of subvalvular structure and proliferation of fibrous endothelial tissue.We have developed a prosthetic valve with zero left ventricular occupancy.The valve frame is appropriately higher than the existing products,slightly chimney shaped,fully accommodates the movement of the valve leaves in the valve frame,and completely supraannular surgical implantation.This study uses this valve for preclinical animal test.Methods Seven sheep underwent the replacement of the artificial valve under the direct vision of cardiopulmonary bypass.Warfarin was used for anticoagulation for 6 months 24 hours after operation.The blood biochemistry,anticoagulation and cardiac color Doppler ultrasound were detected after operation.The sheep were killed 180 days later for autopsy to observe whether the artificial valve caused thromboembolism.The efficacy and safety of valve were observed.Results Two of the seven sheep died within 24 hours after operation,and five survived for a long time.Later,they were killed at 180 days.The mechanical properties of the artificial valve were good,and there was no thromboembolism around the artificial valve and important organs.The tissue layer of suture ring has been completely organized and endothelial cells,and the thickness of tissue layer is about 0.6-1.0 mm.The mitral valve of experimental animals can be opened and closed freely,with smooth surface and no abnormal echo.The follow-up of color Doppler ultrasound showed that the left ventricular ejection fraction was normal(0.60-0.70)before and 6 months after operation.The results of cross valve pressure difference and blood flow velocity of artificial valve were good(vmean was far lower than 5 mmHg(1 mmHg=0.133 kPa)and pmean was lower than 1 m/s),suggesting that the hemodynamic performance of artificial valve was good.Left ventricular retrograde angiography showed that the artificial va

关 键 词：环上型置入 烟囱形机械瓣 动物实验 

分 类 号：R654.2[医药卫生—外科学]