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The evaluation in the valve sparing aortic root reconstruetion, with the cardio vascnlar endoscopy

心血管内镜在保留瓣膜的主动脉根部重建中的评价

基本信息

批准号：
08671532
负责人：
ITOH Tsuyoshi
金额：
$ 1.47万
依托单位：
Saga Medical School
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1996
资助国家：
日本
起止时间：
1996 至 1997
项目状态：
已结题

项目摘要

1.The relationship of the sinotubular junction (STJ) with aortic regurgitaion (AR)(1) Experimental methodUsing mongrel dogs, the beating heart models were made with perfusion through the aortic root and left atrium with the Tyrode's solution. A six sutures were placed in each commissure and each sinus of Valsalva at the level of STJ.By restracting the sutures outwaeds, delatation of aortic root was simulated. While changing retraction sites, direct images of valve coaptation were recorded with endoscope. Additionally, the strain of the sutures were changed by the gravity.(2) ResultWith the increase on the strain of the sutures, the opening of the aortic valve was exaggerated when either all sutures or the commissures was retracted. In cases of the drawing only three sinuses of Valsalva, the coaptation of the aortic valve was kept uninterrupted. This study validated that the dilatation of STJ cause AR.2.The behavior of the aortic valve under remodeling procedure(1) Experimental methodThe beating heart model was made with same method as 1-(1). Using the cardeac endoscopy and high speed video (200frames/second), the behavior of the aortic valve was investigated under noumal condition (Group 1) and the aortic root reconstruction with remodeling procedure (Group 2)Experimental resultThe pattern of the behavior of the aortic valve was almost equal between Group 1 and 2. With Group 2, the maximum opening of the aortic valve was recorded at the time of maximum aortic pressure. It was concluded that the aortic root reconstruction with remodeling procedure was valuable technique in preserving the aortic valve function.3.Clinical experimentsTo date, seven aortic root reconstructions preserving native valve were perfoumad. In six cases, the evaluation of aortic valve was performaed with endoscopy. Cardiec endoscopy was useful technique in evaluation of the etiology of the valeve imcopetence, selection of the procedure and the result of the plasty.

1.窦管连接部(STJ)与主动脉瓣反流(AR)的关系(1)实验方法以杂种犬为主，经主动脉根部和左心房灌注Tyrode溶液，制作不停跳心脏模型。在 STJ 水平的每个连合处和每个 Valsalva 窦处放置 6 根缝合线。通过将缝合线向外收缩，模拟主动脉根部扩张。当改变牵开部位时，用内窥镜记录瓣膜接合的直接图像。此外，重力也改变了缝线的应变。(2)结果随着缝线应变的增加，当所有缝线或连合处回缩时，主动脉瓣的张开程度增大。在仅绘制三个瓦氏窦的情况下，主动脉瓣的接合保持不间断。本研究验证了STJ扩张引起AR。2.主动脉瓣重构过程中的行为(1)实验方法采用与1-(1)相同的方法制作不停跳的心脏模型。使用心脏内窥镜和高速视频（200帧/秒），研究了正常条件下主动脉瓣的行为（第1组）和主动脉根部重塑过程重建（第2组）。实验结果第1组和第2组之间主动脉瓣的行为模式几乎相同。第2组中，在最大主动脉压力时记录主动脉瓣的最大开度。结论主动脉根部重建术是保留主动脉瓣功能的有价值的技术。3.临床实验迄今为止,已完成7例保留自体瓣膜的主动脉根部重建术。在六例病例中，通过内窥镜检查对主动脉瓣进行了评估。心脏内窥镜检查是评估瓣膜功能不全的病因、手术选择和成形术结果的有用技术。