CN113812998A - Puncture reconstruction system for ventricular aneurysm - Google Patents
Puncture reconstruction system for ventricular aneurysm Download PDFInfo
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- CN113812998A CN113812998A CN202111110102.5A CN202111110102A CN113812998A CN 113812998 A CN113812998 A CN 113812998A CN 202111110102 A CN202111110102 A CN 202111110102A CN 113812998 A CN113812998 A CN 113812998A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
- A61B17/12122—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder within the heart
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12027—Type of occlusion
- A61B17/1204—Type of occlusion temporary occlusion
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12136—Balloons
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12159—Solid plugs; being solid before insertion
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B2017/1205—Introduction devices
- A61B2017/12054—Details concerning the detachment of the occluding device from the introduction device
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- Heart & Thoracic Surgery (AREA)
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Abstract
The invention discloses a ventricular aneurysm puncture reconstruction system, and relates to the technical field of medical instruments. The balloon body is in a retracted state and is pushed forwards after being supported at the opening part of the sheath tube, the inner rivet body and the right-angle locking device in multiple sections are connected through the connecting guide wire, the inner rivet body is sent into the sheath tube, the head end of the inner rivet body is bent out of the sheath section by section at the balloon body until the front half part of the right-angle locking device, the inner rivet body is pulled and connected, the inner rivet is retracted after being adjusted in place and isolated from the balloon, the isolating balloon and the sheath tube are withdrawn, the connecting guide wire is tightened and penetrates through a steel wire hole of the free wall rivet body part, the connecting guide wire is tightened and is pushed to the free wall rivet body part, the side screw is tightly clamped with the inner rivet through an interface, and the side screw is locked. The invention simplifies the operation process, reduces the use of interventional instruments, reduces the risk of puncturing and damaging the tricuspid chordae tendineae, has higher puncturing safety, reduces the operation difficulty and has wide application prospect.
Description
Technical Field
The invention relates to the technical field of medical instruments, in particular to a ventricular aneurysm puncture reconstruction system.
Background
Over the last three decades, medical, interventional/implantable devices and surgical treatments for the inhibition of the neuroendocrine system have made great progress in the treatment of heart failure. Heart failure, one of the ultimate outcomes of all heart diseases, is always threatening human health and has an even worse 5-year survival rate than some malignancies. The latest national cardiovascular disease report shows that the mortality of the myocardial infarction patients in China is obviously increased. From 2005 onwards, the mortality rate of acute myocardial infarction in rural areas has shown a rapidly rising trend. Ventricular remodeling following acute myocardial infarction, especially in the case of antemural transmural myocardial infarction, is more likely to occur due to myocardial injury and subsequent scarring. Clinically, heart failure patients with severe ventricular wall remodeling due to myocardial ischemia manifest as recurrent episodes of dyspnea, edema, weakness, etc. of varying degrees, which can even lead to sudden death. There is much debate over whether performing left ventricular reconstruction surgery can improve the clinical prognosis of patients based on cardiac surgical coronary artery bypass grafting, especially in the largest randomized controlled studies of surgical ventricular aneurysm reconstruction, where surgical left ventricular reconstruction does not improve patient prognosis based on coronary revascularization.
In recent years, with the continuous progress of cardiac imaging and minimally invasive techniques, epicardial left ventricular reconstruction has emerged, which can significantly reduce left ventricular volume and improve cardiac function in patients. The operation comprises the steps of puncturing the continuous myocardial infarction scars at the free wall of the left ventricle and the ventricular septum, sending a right ventricular rivet through the right internal jugular vein after a channel is established, folding the transmural myocardial infarction scars after the left ventricular free wall rivet sent by the thoracic cavity side incision is connected, eliminating the paradoxical motion of the ventricular aneurysm, and reducing the volume of the left ventricle. However, the technical solution still has the following disadvantages:
(1) the method needs to puncture the ventricular septum to the right ventricle for multiple times, and the right ventricle is often punctured to cause pericardial effusion or pericardial tamponade;
(2) the track operation from the left ventricle free wall → the right heart → the right internal jugular vein is complicated and the operation time is long: after the puncture chamber is successfully spaced, a guide wire is fed, a 5F sheath catheter is fed under the support of the guide wire, a 5F Ampdaz R catheter is fed along the sheath catheter, the catheter is adjusted to face the direction of the outflow tract of the right chamber, and a guide wire of 0.035mm is fed and placed in the outflow tract of the right chamber or the pulmonary artery; a floating catheter is sent along the right internal jugular vein and is led to the outflow tract of the right ventricle or the pulmonary artery through the tricuspid valve, a guide wire of 0.035mm is caught by a catcher and then pulled out, and a track is established. The operation process is complicated, the requirement on operators is high, and the time is long;
(3) the right intraventricular rivet needs to be sent to the right ventricular surface of the ventricular septum from the right internal jugular vein and then sent to the right ventricular surface along the track established, and the right intraventricular rivet is easy to hook and wind the tricuspid valve chordae tendineae through the tricuspid valve and the position of the rivet is adjusted, so that the tricuspid valve structure is damaged after the rivet is locked.
In order to solve the above problems, it is necessary to develop a new type of ventricular aneurysm puncture reconstruction system.
Disclosure of Invention
Aiming at the defects in the prior art, the invention aims to provide a ventricular aneurysm puncture reconstruction system, which simplifies the operation process, reduces the use of interventional instruments, reduces the operation time, reduces the operation difficulty, effectively reduces the risks of puncturing and damaging the tricuspid valve and is easy to popularize and use.
In order to achieve the purpose, the invention is realized by the following technical scheme: a ventricular aneurysm puncture reconstruction system comprises an isolation saccule at the top, an inner rivet and a free wall rivet, wherein the inner rivet is designed to be bendable, the isolation saccule comprises a saccule body and a saccule connecting pipe, the inner rivet comprises an inner rivet body, a connecting guide wire and a right angle locking device, the free wall rivet comprises a free wall rivet body, a gap, a steel wire hole and a side screw, the saccule body is connected with the saccule connecting pipe, the saccule body passes through a sheath pipe in a retracted state, the saccule body is pushed forwards after being propped up at the opening part of the sheath pipe, the multi-section inner rivet body and the right angle locking device are connected through the connecting guide wire, the inner rivet body is sent by the sheath pipe, the head end of the inner rivet body is bent out of a sheath section by section at the saccule body until the front half part of the right angle locking device, the inner rivet body is pulled to tighten up by the connecting guide wire, the isolation saccule is retracted after the inner rivet is adjusted in place, and the isolation saccule and the sheath pipe are withdrawn, and the tightening connecting guide wire penetrates through the steel wire hole of the free wall rivet body, the connecting guide wire is tightened, the free wall rivet body is pushed, and the connecting guide wire is tightly clamped with the inner rivet through the middle connector to lock the side screw.
Preferably, the two ends of the connecting guide wire are respectively a movable end and a fixed end, the inner rivet body is tightened by pulling the movable end of the connecting guide wire, the right-angle locking device is in a right-angle shape, and the inner rivet is integrally connected into a right-angle cylindrical body.
Preferably, the number of the inner rivet body is adjustable, and the length of the inner rivet can be adjusted by adjusting the number of the inner rivet body in front of the right-angle locking device according to the puncture position and the corresponding length of the myocardial infarction scar.
Preferably, after the inner rivet is placed, left ventricle radiography is carried out, and the ideal effect is confirmed through thoracic heart color Doppler ultrasound, and then the connecting guide wire is cut off.
Preferably, when the inner rivet is punctured and implanted, aiming at the conditions that a myocardial infarction scar is long and a puncture point is located in the middle part, the two inner rivets with opposite directions are implanted into the sheath tube by puncturing once, and are fixed by the long free wall rivet, so that the puncturing risk is reduced, and the operation flow is simplified.
The invention has the beneficial effects that: the invention simplifies the operation flow, reduces the use of interventional instruments, prevents the inner rivet from hooking and winding with the tricuspid valve chordae tendineae by the saccule at the top, and also provides positioning for the subsequent ventricular septal puncture, thereby greatly reducing the risk of puncturing and damaging the tricuspid valve and ensuring higher puncture safety; meanwhile, the length-adjustable inner rivet and the bidirectional implantation thereof are adopted, so that the operation flow is simplified, the operation time is shortened, the operation difficulty is reduced, and the application prospect is wide.
Drawings
The invention is described in detail below with reference to the drawings and the detailed description;
FIG. 1 is a schematic flow chart of the operation of the present invention;
FIG. 2 is a schematic structural view of the present invention with two internal rivets implanted at a time;
FIG. 3 is a schematic view of the present invention using a long free wall rivet to secure two inner rivets.
Detailed Description
In order to make the technical means, the creation characteristics, the achievement purposes and the effects of the invention easy to understand, the invention is further described with the specific embodiments.
Referring to fig. 1 to 3, the following technical solutions are adopted in the present embodiment: the ventricular aneurysms puncture reconstruction system comprises an isolation saccule at the top, an inner rivet and a free wall rivet, wherein the inner rivet is designed to be bendable, the isolation saccule comprises a saccule body 1 and a saccule connecting pipe 2, the inner rivet comprises an inner rivet body 3, a connecting guide wire 4 and a right-angle locking device 5, the free wall rivet comprises a free wall rivet body 6, an interface 7, a steel wire hole 8 and a side screw 9, the saccule body 1 is connected with the saccule connecting pipe 2, the saccule body 1 is pushed forwards after being propped up by an opening of a sheath pipe 10 in a retracted state, and the inner rivet is prevented from being hooked and wound around a tricuspid valve tendon when the right ventricle is unsheathed and adjusted; the multi-section inner rivet body 3 and the right-angle locking device 5 are loosely connected through the connecting guide wire 4, the inner rivet body 3 is fed by the sheath tube 10, the head end of the inner rivet body 3 is bent out of the sheath section by section at the balloon body 1 until the front half part of the right-angle locking device 5, the connecting guide wire 4 is pulled to tighten the inner rivet body 3, so that the inner rivet is connected into a right-angle cylindrical body, the isolating balloon is retracted and retracted after the inner rivet is adjusted to the optimal position, the isolating balloon and the sheath tube 10 are withdrawn, the connecting guide wire 4 for tightening the inner rivet penetrates through the steel wire hole 8 of the free wall rivet body 6, the connecting guide wire 4 is tensioned and pushes the free wall rivet body 6, the free wall rivet body is tightly clamped with the inner rivet through the intermediate port 7, and the side screw 9 is locked.
It is worth noting that the two ends of the connecting guide wire 4 are respectively a movable end 4-1 and a fixed end 4-2, the inner rivet body 3 is tightened by pulling the movable end 4-1 of the connecting guide wire 4, the right-angle locking device 5 is in a right-angle shape, and the inner rivet is integrally connected into a right-angle cylindrical body.
It is worth noting that the number of the inner rivet body 3 can be adjusted, and the length of the inner rivet can be adjusted by adjusting the number of the inner rivet body 3 in front of the right-angle locking device 5 according to the puncture position and the corresponding length of the myocardial infarction scar.
In addition, when the inner rivet is punctured and implanted, aiming at the condition that a myocardial infarction scar is long and a puncture point is positioned in the middle part, the two inner rivets with opposite directions are implanted into the sheath tube by one-time puncture and are fixed through the long free wall rivet 11.
This embodiment is through puncturing free wall of left ventricle to ventricular septum continuity myocardial infarction scar, connects the guide wire guidance and sends into the sheath pipe, and through the sheath pipe with the pushing of ventricular aneurysm puncture reconstruction system to right ventricle, the isolation sacculus at expansion top sends into flexible design's interior rivet, can with the fixed clamping of outer anchor after the adjustment position and close the ventricular aneurysm, specifically, its operation flow is as follows:
(1) the method comprises the steps of strictly screening heart failure patients with old myocardial infarction combined with the formation of the ventricular aneurysm before an operation, fully evaluating the range of myocardial infarction scars by cardiac imaging, selecting the patients with left ventricular free wall-ventricular continuous myocardial infarction scars, eliminating contraindications of the operation, and fully and informed consent to the possible benefits and risks brought by the reconstruction of the left ventricular aneurysm.
(2) After general anesthesia intubation, the right internal jugular vein is punctured and sent into a pigtail catheter for right ventricular radiography, a puncture needle is used for puncturing the free wall of the left ventricle to the interventricular continuous myocardial infarction scar to the right ventricle under the guidance of a left intercostal side incision or a thoracoscope, and the puncture needle is sent into a 5F arterial sheath after the radiography confirmation.
(3) The ventricular aneurysm puncture reconstruction system is pushed to the right ventricle through the sheath tube 10, the isolation balloon at the top is unfolded, the bendable and length-adjustable inner rivet (figure 1-A) is fed until the front half part of the right-angle locking device 5 is exposed out of the arterial sheath (figure 1-B), and the movable end 4-1 of the connecting guide wire 4 is pulled, so that the inner rivet is in a fixed right-angle shape (figure 1-C).
(4) And (3) removing the isolating saccule, pulling out the sheath tube 10, enabling the movable end 4-1 of the connecting guide wire 4 to penetrate through the steel wire hole 8 of the free wall rivet, pushing the free wall rivet body 6 to clamp the inner rivet, locking the side screw 9 after reaching an ideal position, and adjusting the side screw 9 to be loosened for adjustment if necessary. After a plurality of pairs of rivets are placed, left ventricle radiography is carried out, and the ideal effect is confirmed through the thoracic heart color Doppler ultrasound, and then the connecting guide wire 4 is cut off (shown in figure 1-D).
(5) If the myocardial infarction scar is longer and the point of puncture is located the middle part, can puncture once and send into two opposite direction's interior rivets by in sheath 10 to use long free wall rivet 11 fixed, can reach the effect of once puncturing, implanting two opposite direction rivets, reduce the puncture risk, simplify the operation procedure.
The specific embodiment is used for reconstructing the left ventricle without establishing a track of a free wall of the left ventricle → the right heart → a right internal jugular vein, puncturing the free wall of the left ventricle → an interventricular myocardial infarction scar, and by sending the system, unfolding the isolation balloon at the top, sending an inner rivet with a bendable design, and adjusting the position, the position can be fixed with an outer anchor to clamp the ventricular aneurysm. The technical advantages are as follows:
firstly, the system only needs to puncture the free wall and the compartment space, does not need to establish a special track, is simple and easy to operate, greatly optimizes the operation flow and reduces the operation time and difficulty; the inner rivet does not need to penetrate through the internal jugular vein and the tricuspid valve, so that the risk of puncturing and damaging the tricuspid valve is reduced;
the design structure of the top isolation balloon is adopted, so that the risk of hooking and winding the tricuspid valve chordae tendineae during the adjustment of the inner rivet is reduced, the isolation balloon can provide reference and protection for the next puncture, and the risk of ventricular septal puncture is greatly reduced;
the bendable inner rivets are adopted, two inner rivets in opposite directions can be implanted in a one-time puncture mode, and the bendable inner rivets are matched with the rivets with long free walls for use, so that the operation steps and the frequency of intervals of puncture chambers are reduced, and the operation time is shortened;
the length of the inner rivet can be flexibly adjusted according to the puncture position and the corresponding length of the myocardial infarction scar, the defect of uniform length of the rivet in the traditional technology is overcome, the flexibility is better, and the practicability is higher;
the saccule or the locked inner rivet can be used as puncture reference in the operation, so that the accuracy of the puncture chamber interval is improved, the occurrence of heart perforation is avoided, and the safety is high.
The foregoing shows and describes the general principles and broad features of the present invention and advantages thereof. It will be understood by those skilled in the art that the present invention is not limited to the embodiments described above, which are described in the specification and illustrated only to illustrate the principle of the present invention, but that various changes and modifications may be made therein without departing from the spirit and scope of the present invention, which fall within the scope of the invention as claimed. The scope of the invention is defined by the appended claims and equivalents thereof.
Claims (5)
1. The ventricular aneurysm puncture reconstruction system is characterized by comprising an isolation balloon at the top, an inner rivet and a free wall rivet, wherein the inner rivet is in a bendable design, the isolation balloon comprises a balloon body (1) and a balloon connecting pipe (2), the inner rivet comprises an inner rivet body (3), a connecting guide wire (4) and a right angle locking device (5), the free wall rivet comprises a free wall rivet body (6), an interface (7), a steel wire hole (8) and a side screw (9), the balloon body (1) is connected with the balloon connecting pipe (2), the balloon body (1) is pushed forwards after being propped up at the opening of a sheath pipe (10) through the sheath pipe (10) in a folding state, the inner rivet body (3) and the right angle locking device (5) are connected through the connecting guide wire (4), the inner rivet body (3) is fed through the sheath pipe (10), the head end of the inner rivet body (3) is bent out of the balloon body (1) section by section, until the front half part of the right-angle locking device (5), the connecting guide wire (4) is pulled to tighten the inner rivet body (3), the isolating saccule is retracted after the inner rivet is adjusted in place, the isolating saccule and the sheath tube (10) are withdrawn, the connecting guide wire (4) is tightened to penetrate through the steel wire hole (8) of the free wall rivet body part (6), the connecting guide wire (4) is tensioned and the free wall rivet body part (6) is pushed, and the side screw (9) is locked through the clamping of the middle connector (7) and the inner rivet.
2. The ventricular aneurysm puncture reconstruction system according to claim 1, wherein the two ends of the connecting guide wire (4) are respectively a movable end (4-1) and a fixed end (4-2), the inner rivet body (3) is tightened by pulling the movable end (4-1) of the connecting guide wire (4), the right-angle locking device (5) is right-angled, and the inner rivet is integrally connected into a right-angled cylinder.
3. The system for the ventricular aneurysm puncture reconstruction according to claim 1, wherein the number of the inner rivet body (3) is adjustable, and the length of the inner rivet is adjusted by adjusting the number of the inner rivet body (3) in front of the right-angle locking device (5) according to the puncture position and the length of the corresponding myocardial infarction scar.
4. The ventricular aneurysm puncture reconstruction system according to claim 1, wherein the connecting guide wire (4) is cut off after the inner rivet is placed and left ventricular radiography is performed and the ideal effect is confirmed through a thoracic heart color Doppler ultrasound.
5. The ventricular aneurysm puncture reconstruction system according to claim 1, wherein the inner rivet puncture is implanted in a state that the myocardial infarction scar is long and the puncture point is located in the middle, and two punctures are implanted in the sheath tube at one time in opposite directions and fixed by the long free wall rivet (11).
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CN202111110102.5A CN113812998B (en) | 2021-09-18 | 2021-09-18 | Puncture reconstruction system for parietal tumor |
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