RU2208399C2 - Method for treating myocardial defect at acute myocardial infarction - Google Patents

Abstract

FIELD: medicine, cardiology. SUBSTANCE: the present innovation deals with treating myocardial defect, the rupture of interventricular septum at acute myocardial infarction. Balloon catheter is introduced into main vein, then it is directed into right ventricle and then - into left ventricle through defect in interventricular septum. Solution is supplied into catheter's balloon. Enlarged catheter's balloon is put into the rupture of interventricular septum. It is possible to introduce guide-chorda into balloon catheter's opening. Moreover, after applying balloon catheter through the rupture of interventricular septum into left ventricle the above-mentioned guidechorda is withdrawn out of catheter's opening to supply solution into balloon catheter. Enlarged balloon is introduced into the rupture of interventricular septum. EFFECT: higher efficiency of therapy. 1 cl

Description

 The proposed technical solution relates to medicine, namely to cardiology, and is intended for the treatment of myocardial defect and, in particular, rupture of the interventricular septum (MJP) in acute myocardial infarction (MI).

 Under the rupture of the MJP, one should understand its acute defect with the formation of an intracardiac shunt, that is, the discharge of arterial blood from the left ventricle (LV) to the right.

 The rupture of the MJP is considered to be a mechanical complication of myocardial infarction, which can also be attributed to the acute development of mitral valve insufficiency and rupture of the outer wall of the myocardium. These complications occur in 1-3% of cases of all hospitalized patients with MI, 30-50% of them occur on the first day of illness (Acute myocardial infarction: pre-hospital and in-hospital management (The Task Force on the Management of Acute Myocardial Infarction of the European Sosiety of Cardiology), Europ. Heart J., 1996.17, p. 43-63). Some authors believe that myocardial rupture is the cause of death in MI in 10-15% of cases (Alpert J., Francis G. Treatment of myocardial infarction. Practical guide: Transl. From English. - M.: Practice, 1994. P 150) . A MJ defect is formed almost immediately after the onset of MI and its incidence rate is 1–2% of the total number of heart attacks (Lavie C.J., Gersh B.J. Mechanical and electrical complications of acute miocardial infarction. Mayo Clin. Proc. 1990; 65: 709-33).

 It is possible to suspect a rupture of the MJP or a rupture of the papillary muscle by the characteristic systolic murmur and the rapid progression of heart failure. The rupture of the outer wall in the acute case is characterized by collapse and electromechanical dissociation. Resuscitation is usually ineffective. With a subacute form of external rupture, classic symptoms of cardiac tamponade appear.

 In patients with rupture of the MJP, intense systolic murmur is always noted with an epicenter at the lower left edge of the sternum. Conversely, even with severe mitral regurgitation, the noise intensity may be small. It is often difficult to distinguish the noise of acute mitral regurgitation from the noise arising from rupture of the MZHP. Doppler echocardiographic examination allows you to correctly establish the diagnosis.

 Without surgery, mortality during the first week is 54% and 92% during the first year (Sanders R.J., Kern W.H., Blaunt S. G. Perforation of the interventricular septum complication acute miocardial infarction. Am. Heart J. 1956; 21: 736). Surgery is the only chance for survival in the presence of extensive post-infarction defects in breast cancer with cardiogenic shock (Lemery R., Smith HC, et al. Prognosis in rupture of the ventricular septum after acute miocardial infarction role of early surgical intervention. Am. J. Cardiol. 1992; 70: 147-51). The purpose of the early operation is to close the defect using the patch technique (Dagget W. M., Guiyon R. A., Mundth E. D. et al. Surgery for myocardial infarction ventricular septal defect. Ann. Surg. 1997; 206-71). Hospital mortality after surgery is estimated to be between 25 and 60% (!), And 95% of survivors have symptoms of chronic heart failure (Piwnica A. Update in surgical treatement of acute postinfarction ventricular septal defects and myocardinal regurgitation. Eur. J. Cardiothorac. Surg. 1995. ; 9: 117-19).

 High hospital mortality in patients with rupture of MJP after surgical treatment makes us look for other ways to correct the defect of MJP in patients with myocardial infarction.

 In 1975, Dr. King and Mills reported transcatheter closure of the atrial defect to several patients using an original double-umbrella device. This system was quite effective, but a large diameter catheter was needed to use it. Subsequently, similar systems were used to close the open ductus arteriosus. Since 1989, a modified system of "double umbrellas" has been admitted to clinical trials, providing greater pressure on the "umbrellas", which gave the system a look resembling a "mollusk shell". Cardiologists have always been attracted by the possibility of closing the defects of the breast. Since such defects are rare, there is no sufficient clinical experience in closing muscle defects of the pancreas (C. Malins. Transcatheter occlusion of defects of the atrial and interventricular septa. Materials of the international symposium "X-ray endovascular surgery of heart defects" RAMS, AV Vishnevsky Institute of Surgery, Moscow, 19 - 04/20/1994, p. 89-90).

 Summarizing, we can say that due to the intensive development of invasive techniques, it is now possible to close defects of the breast with the help of special devices: a "double umbrella" or "clam shell", however, it was not proposed to use such systems in acute myocardial infarction.

 The closest in technical essence and the achieved result is a way to close the defects of MJP during myocardial infarction (KOBUS C. et al. [Interventricular rupture following myocardial infarction. Surgical treatment and long-term follow-up]. Rev Esp Cardiol, 1992 Oct; 45 ( 8): 520-4). In this case, the closure of the defect MZHP is carried out by hemming the patch.

 A disadvantage of the known technical solution is the invasiveness of the operation, which can lead to the development of complications and aggravate the already serious condition of the patient.

 The aim of the proposed method for the treatment of heart disease is to increase the effectiveness of the treatment of one of the most formidable complications of myocardial infarction - rupture of the MJP.

 This goal is achieved in that a balloon catheter is used to close the defect in the MJP, which is performed by puncture of the main vein through the right atrium, right ventricle and existing septum rupture in the LV, followed by ballooning of the balloon segment of the device. With a blood flow, the balloon occludes (closes) an existing interventricular septal defect, eliminating pathological blood bypass surgery.

 The proposed technical solution makes it possible to reproduce the object by technical means and is aimed at preserving and strengthening the patient's health. At the same time, the possibility of its practical implementation was confirmed and a specific way to solve the problem was indicated, moreover, a double-lumen catheter of the Swan-Ganz type with a diameter of 8F can play the role of an occlusion catheter, X-ray control and recording of results on a film can be performed using a Philips DIAGNOST ARC X-ray diagnostic unit (Netherlands), ultrasound monitoring can be carried out using an APOGEE-800, ATL (USA) echocardiograph as a solution for inflation In case of balloon catheter, physiological saline or 76% urographin solution can be used during occlusion.

 The novelty of the proposed method consists in the fact that for the first time it has been proposed to produce extravenous closure of the defect of the MJP in acute myocardial infarction, and not with congenital heart defects. In this case, the intervention is practically performed for health reasons, that is, to save the patient's life.

 The proposed technical solution at this stage of the development of cardiology is practically applicable, and its difference with the known prototype solution allows you to change its property, the result of which is its effectiveness. The inventive step of the proposed method consists in using balloon catheters to close the defect of the MJP in acute myocardial infarction, using the technical technique itself - through the emergency closure of the MJP defect precisely in AMI, using additional technology for holding the balloon through the MJP defect using a string.

 The advantages of this method include its cheapness and ease of practical application.

 Comparison of the proposed technical solution with other technical solutions (see patents WO 82/00581, MKI A 61 V / 00. Method for measuring the characteristics of the cardiovascular system, 83/04181, MKI A 61 N 1/04. The input node of the heart electrode for intravenous channel, 62/00022, MKI A 61 V / 00. Method of sequential intravenous administration of several fluids, 86/03129, MKI A 61 M 29/02. Dilation catheter, 91/06243, MKI A 61 V 5/02. Non-invasive system for diagnostics of coronary heart disease; Patents EP 0024963. Device for introducing and installing the probe, 0024963. Device for taking and re-infusion of blood, 0183314 , MKI A 61 M 29/02. Quick-inflated balloon catheter, 0238170, MKI A 61 B 5/02. Method and device for detecting myocardial infarction; Patents US 4181123, NCI 128-6. Device for cardiac surgery and treatment of cardiovascular diseases, 4185629, MKI 128-214. Method for blood processing, 4014329, NCI 128-214. Method for autotransfusion, 4203451, NCI 128-672. Method for analysis of cardiovascular activity, 4364376, NCI 128-11. A method of introducing a capsule of a substance into a blood vessel, 4282875, NCI 128-214. Device for blocking blood vessels, 4437469, NKI 128-713. System for determining blood flow parameters, 4718423, NKI 128-634. Multifunctional Cardiovascular Catheter System, 4610662, NCI 604-53. A way to eliminate vascular stenosis or increase their lumen, 4739766, NKI 128-653. The method of obtaining NMR images of blood vessels; Patents DE 3130262, MKI A 61 M 25/00. Venous catheter, 3419876, MKI A 61 B 37/04. A device for the administration of drugs, 3617126, MKI A 61 B 5/02. A method for determining narrowing of blood vessels; Patents FR 2387889. X-ray equipment intended primarily for the study of coronary arteries, 2218078, MKI A 61 B 5/02. Heart cycle monitoring equipment; Patent CH 596823, MKI 93 A 61 V 5/02. A method of measuring the health of the heart; Patents Yp 6022/88, MKI A 61 M 1/34. Ultrafiltration device, 15.860 / 88. Device for filtering blood, 12635/88, MKI A 61 M 1/34. A method for continuous fractionation of blood. Copyright certificates SU 637984, MKI A 61 B 5/02. The device for the analysis of indicators of the state of the cardiovascular system, 1246442, MKI A 61 5/02. The method of differential diagnosis of patients with sentimental heart diseases, 1419666. The method for the diagnosis of MI, 1438698, 1593626, 1653733, MKI A 61 B 5/02) shows that it has a new set of essential features, especially since these signs are interconnected, combined into one system and together with known data, a qualitatively new property is achieved.

 The essence of the proposed solution will be clear from the following description.

 The method of closing the MJP defect in acute myocardial infarction involves introducing a balloon catheter into the patient’s main vein along the conductor (string), conducting it into the right atrium, then into the right ventricle, then through the MJP defect in the LV, injecting the solution into the catheter balloon and then the catheter’s balloon installed in the defect (rupture) of the MJP, moving under the influence of blood flow, the balloon occlusive defect MZHP.

 In the second embodiment, the method of closing the defect of the MJP is carried out without using a conductor (string).

 For the practical implementation of the method, sounding of the right parts of the heart is performed and, under ultrasound and x-ray control, the passage of a balloon catheter in the LV is achieved. After installing the tip of the catheter in the LV, a contrast medium (76% solution of urographin) or saline is injected into the balloon segment of the catheter. With blood flow from the LV, the balloon rushes in the direction of the MJP and occludes the existing septal defect. The required location of the balloon segment and the cessation of pathological discharge of blood are assessed using ultrasound methods.

 Here is a description of the clinical observation of patient S., 65 years old, East. Disease 2305: delivered by the cardiological emergency team to the admission department of the Tyumen Research Institute of Clinical and Preventive Cardiology SB RAMS with a diagnosis of acute transmural anterolateral MI. The diagnosis of myocardial infarction is confirmed by the characteristic clinical picture of the disease, the results of laboratory tests, the characteristic dynamics of electrocardiograms, and the presence of myocadic asinergy zones during echocardiographic examination of the heart. On the sixth day of hospitalization, she noted the appearance of shortness of breath, intensifying with minimal physical exertion and when lying down, feeling of suffocation at night, dizziness, and sharp weakness. An objective examination of the condition is serious. Acrocyanosis, pastes of the legs. Auscultatory: respiratory depression, moist rales in the lower parts of the lungs. NPV 20 in 1 min. Heart sounds are muffled, the rhythm is correct, pronounced systolic murmur at all points of auscultation with an epicenter at the left edge of the sternum. Heart rate 110 in min, BP 100/60 mm Hg The abdomen is soft, painless. The 2 cm liver protrudes from under the edge of the costal arch. ECG in dynamics - signs of recurrence of transmural anterolateral MI. Echocardiography in dynamics - revealed a defect in the MJP with pathological discharge of blood from left to right. Examined by a cardiovascular surgeon. The diagnosis of rupture of MJP is confirmed. Surgical treatment is denied due to the severity of the patient's condition. To close the existing defect of the breast, for health reasons, it was decided to use our proposed method.

 Under local anesthesia with a 0.5% novocaine solution 2 cm below the clavicle, a subclavian vein was punctured along the midclavicular line according to Seldinger. Under X-ray and ultrasound control, the tip of a Swan-Ganz balloon catheter was infused into the LV cavity through the right atrium and right ventricle and the defect in the septum, which was inflated by the introduction of 2.5 ml of physiological saline. At the same time, the complete closure of the defect of the MJP and the cessation of pathological discharge of blood from left to right was noted. The next day, almost complete regression of symptoms of circulatory failure was observed.

 This example demonstrates the feasibility and safety of the proposed method for the treatment of rupture of MJP. The simplicity of practical implementation, the absence of the need to use an expensive system for closing defects and the safety of the method indicate its advantages over the well-known prototype. All these advantages can reduce mortality, increase the effect of the therapy, reduce the patient’s hospital stay time, restore lost working capacity, and reduce treatment costs.

 Thus, after analyzing the literature data, patents of the countries of the world, we came to the conclusion that the proposed method for closing the defect of MJP in acute MI can be of great importance, especially since it has been successfully implemented in practice.

Claims (2)

 1. A method of treating an interventricular septal rupture in acute myocardial infarction, characterized in that a balloon catheter is inserted into the main vein, then it is inserted into the right ventricle, then it is passed through the defect of the interventricular septum into the left ventricle, the solution is fed into the catheter balloon, and then swollen a catheter balloon is inserted into the interventricular septum rupture.  2. The method according to claim 1, characterized in that a conductor string is inserted into the opening of the balloon catheter and after the catheter balloon is inserted through the interventricular septum into the left ventricle, the conductor string is removed from the catheter opening, then the solution is fed into the catheter balloon and the balloon is inflated set into the interventricular septum rupture.