RU2200482C2 - Method for setting prostheses of mitral and tricuspid cardiac valves - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves bringing synthetic material attached to papillary muscles of prosthesis to cardiac ventricle surface via through openings made in it. After suturing valve to fibrous ring by pulling the synthetic material, required chordal apparatus length is set. Hydrodynamic test is carried out for the valve. The chordal apparatus length is adjusted by increasing or reducing synthetic material length. The synthetic material is finally fixed by tightening U-shaped sutures on the outer ventricular surface with through holes being concurrently sutured in the corresponding cardiac ventricle. EFFECT: enhanced effectiveness of treatment; prolonged valve service life. 2 dwg

Description

 The invention relates to medicine, namely to cardiac surgery. Known methods for replacing affected atrioventricular heart valves using biological and mechanical prostheses. The methods include pre-excision of the affected valve with subvalvular structures. After that, a heart valve prosthesis is implanted in the position of the atrioventricular valve.

 A known method of implanting a mitral allocidal valve of a human heart (Acar S., Gaer J., Chauvauld S. et al. Technique of homograft replacement of the mitral valve. J. Heart Valve Dis. 1995, vol. 4, p. 31-34), consisting in the following: a dissected human (donor) valve, sterilized in a solution of glutaraldehyde, is placed in the position of the implantable valve, the chordal apparatus is first fixed by directly stapling the papillary muscles of the prosthesis with the patient’s papillary muscles on the gaskets, then the prosthesis ring is fixed continuous seam to the fibrous ring valve. In the immediate post-implantation period, the rapid destruction of an allocap occurs, prosthesis failure appears with the development of cardiomegaly and heart failure. The causes of valve destruction are the separation of chords and the eruption of papillary muscles, fixed by individual U-shaped seams on the gaskets. In addition, it is impossible to reliably accurately determine the length of the subvalvular apparatus due to the difficulty of access to the cavity of the left ventricle, insufficient size of the fibrous ring and insufficient length of the donor chordal apparatus. As a result of this, either incomplete closure of the valves or their prolapse occurs. Poor visualization of the surgical field determines the appearance of such surgical errors as torsion of the papillary muscles or their incorrect fixation, damage to the main chords - all this in a certain way reduces the effectiveness of the operation.

 The objective of the invention is to increase the efficiency of the method by increasing the life of the implantable valve.

 The task is achieved by using for implantation a biological prosthesis modeled during surgery, obtained from cattle or pigs, depending on the needs of the patient, and not having a rigid support ring.

 The method is as follows: excised affected valve with subvalvular structures. Two U-shaped sutures are applied to the wall of the left ventricle in the avascular zone in the projection of the excised own papillary muscles. The wall of the left ventricle is incised, through the formed holes with a diameter of 2-3 mm, synthetic material is brought out, sewn to the heads of the papillary muscles of the prosthesis. A xeno valve is implanted using separate U-shaped sutures placed over the Carpentier ring. After that, a hydraulic test is carried out on the corresponding valve and the length of the formed “neochordi” of the valve is regulated by the level of “floating” of the valves and the degree of residual regurgitation. After reaching the necessary coaptation of the valves, the synthetic material is fixed on the outer surface of the heart with sutures while suturing through holes in the ventricles of the heart.

 Figure 1, A, B shows a diagram of the fixation of synthetic material on the outer surface of the heart. Two U-shaped sutures 1 are placed on the ventricle of the heart and holes 2 are made through which the synthetic ends 3 of the prosthesis are brought to the outer surface of the heart (Fig. 1, A). After the hydrodynamic test, U-shaped sutures 1 are tied, the synthetic ends 3 of the prosthesis are fixed (Fig. 1. B).

 Figure 2 shows a diagram of the implantation of a simulated valve: 1 - the aorta, 2 - the left ventricle, 3 - the left atrium, 4 - sash and fibrous ring of the xeno valve, 5 - chords of the xeno valve, 6 - the head of the papillary muscles sheathed with synthetic material, 7 - scheme fixation of the xeno valve neochord to the wall of the left ventricle.

 At the first stage, it is impossible to perform such a simulation, since the valve is not fixed to the fibrous ring and it is impossible to conduct a hydrodynamic test.

Concrete example
In the experiment, the heart of a 43-year-old patient with mitral defect was used. The first stage excise the affected mitral valve with subvalvular structures. Two U-shaped sutures are applied to the wall of the left ventricle in the avascular zone in the projection of the excised own papillary muscles. A wall of the left ventricle is pierced with a scalpel in the area of U-shaped sutures, synthetic material sewn to the heads of the papillary muscles of the prosthesis is brought out through the openings with a diameter of 2 mm. A 33 mm diameter xeno valve is implanted using 16 U-shaped sutures placed on the mitral valve fibrous ring and Carpentier ring. A hydraulic test is carried out on the corresponding valve and the length of the formed “neochordi” of the valve is regulated by the level of “floating” of the valves and the degree of residual regurgitation. After achieving complete coaptation of the valves, the synthetic material (neochords) is fixed on the outer surface of the heart with sutures with simultaneous suturing of through holes in the ventricles of the heart and the incision of the left atrium is sutured.

 The proposed method for prosthetics of the mitral and tricuspid heart valves using a simulated biological xeno valve is simple and inexpensive. According to the proposed technique, the prosthesis can be implanted in the position of the mitral and tricuspid valves. This method can be used in the clinic for the correction of congenital and acquired heart defects in patients with coronary heart disease with combined pathology.

Claims (1)

 A method of prosthetics of the mitral and tricuspid valves of the heart, which consists in fixing the chordal apparatus and suturing the valve to the fibrous ring, characterized in that they first conduct synthetic material fixed to the papillary muscles of the prosthesis on the surface of the corresponding ventricle of the heart through the through holes made in it, after suturing the valve pulling the synthetic material to the fibrous ring, set the required length of the chordal apparatus, perform a hydrodynamic test on lapane, carried chordal length correction device by reducing or increasing the length of the synthetic material and finally fixed with synthetic material by tightening the U-shaped seam on the outer surface of the heart ventricle while suturing through holes in the respective ventricle.

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