RU2257156C2 - Method for surgical correction of paraprosthetic endocarditis of atrioventricular valves - Google Patents

Abstract

FIELD: medicine, cardiosurgery.

SUBSTANCE: the method deals with valvular reprosthetics. After dissecting a prosthesis and treating infectious foci with antiseptics it is necessary to implant a carcass xenoprosthesis faced with epoxy-treated xenopericardium. At implanting xenoprosthesis into mitral position it should be fixed in position of fibrous ring by separate P-shaped sutures, one part of which could be upon interlayers. At implanting xenoprosthesis into tricuspid position it should be fixed in position of fibrous ring, moreover, septal valve should be fixed with separate P-shaped sutures, anterior valve - in the middle with a single P-shaped suture, The rest length of xenoprosthesis should be fixed with uninterrupted blanket suture.

EFFECT: decreased chance for prosthetic infectioning.

2 ex

Description

The present invention relates to medicine, namely to cardiac surgery, and can be used for the surgical treatment of paraprosthetic endocarditis of the mitral and tricuspid valves.

A known method of surgical treatment of prosthetic endocarditis of atrioventricular valves, including reprosthesis of the valve, the cuff of which is treated with antiseptics.

However, the prototype has several disadvantages.

1. the cuff of the mechanical prosthesis remains;

2. When using the xeno valve, the artificial tissue remains, with which the prosthesis frame is sheathed.

That is, there remains a substrate for the infection to penetrate into the cells of the tissue base with the formation of an infectious focus, which again leads to a relapse of parasthetic endocarditis with the possible formation of blood clots, abscesses, fistulas.

In order to eliminate these drawbacks, we offer a method for the surgical treatment of paraprosthetic endocarditis, characterized in that xenopericardium treated with epoxy compounds is used for suturing the xeno valve, which makes xenotissue more resistant to infection compared with glutaraldehyde treatment. At the same time, surgical correction of paraprosthetic endocarditis with a frame xenoprosthesis sheathed with epoxy-treated xenopericardium allows to achieve a positive therapeutic effect.

The method is carried out in the following sequence.

1. Access to the heart - median or right anterolateral thoracotomy.

2. Isolation of the great vessels.

3. Providing a "dry" heart - nonperfusion hypothermic protection or cardiopulmonary bypass.

4. Access to the atrioventricular valve.

5. Excision of the valve prosthesis.

6. The implementation of the method.

7. Recovery of adequate cardiac activity.

After performing access to the heart, we proceed to the isolation of the great vessels according to a technique that does not differ from well-known ones. Further, ensuring the conditions of a "dry" heart, either under conditions of non-perfusion hypothermic protection through occlusion of the great vessels, or in conditions of cardiopulmonary by a conventional technique. The intracardiac stage begins with an audit of the cavities of the heart and atrioventricular prostheses. The prosthesis is excised. Detected foci of infection (abscesses, ulcerative surfaces, etc.) are treated with antiseptic solutions. In the position of the mitral valve fibrous ring, a frame xenoprosthesis sheathed with epoxy-treated xenopericardium is implanted on separate U-shaped sutures, some of which can be on the spacers (to avoid eruption of sutures). To the position of the fibrous ring of the tricuspid valve: along the perimeter of the septal leaflet - separate U-shaped seams, in the middle of the perimeter of the anterior leaflet - a single U-shaped seam, throughout the rest - continuous continuous. Sealing cavities and restoring adequate cardiac activity.

An example of implantation in the mitral position.

Patient O., 57 years old, and / b No. 3751/1. He entered the Novosibirsk Scientific Research Institute of Circulatory Pathology on August 6, 2001. In April 2001 he was operated on at the Scientific Research Institute of PC for an acute mitral-aortic defect against the background of active infectious endocarditis. Aortic valve prosthetics was performed using the Kemerovo-AB-mono-25 xenoprosthesis, and the mitral prosthesis, KemKor-30. In crops - Staphylococcus aureus. The postoperative period proceeded with a pronounced activation of the infectious process. At discharge, the activity of the process according to laboratory data - II Art. 07/29/01 - a sharp deterioration in the condition: severe weakness, shortness of breath, palpitations.

At the clinic of the Scientific Research Institute of PK, the diagnosis was established: primary infective endocarditis, activity of the II stage Fistula of the mitral prosthesis. Mitral and aortic valve replacement surgery (April 2001). H II B.

Echocardiography. MK: shadow of a biological prosthesis, works without failures, the amplitude of movement of the locking element is 15 mm, the peak diastolic gradient is 27 mm Hg. (average - 6.7), effective area 3.4 cm ² . Between the wall of the heart and the braid of the prosthesis, a discharge into the cavity of the left atrium is recorded in volume closer to the expressed one. PL 5.8 cm. AoK - the edges of the valves are unevenly thickened, a reverse jet is recorded from their level, insignificant in volume.

The presence of a paannular fistula of the mitral prosthesis with a significant volume of discharge, NK II B, requires correction of the defect according to vital indications, despite the activity of infectious endocarditis of the II st.

On August 24, 2001, an operation was performed: prosthetics with a xenoprosthesis of Kemerovo production, sheathed with epoxy-treated xenopericardium. On the operation: the fistula of the mitral valve prosthesis in the projection of the posterior valve, where there was an opened abscess of the fibrous ring and the posterior valve, not dissected during the operation, for 1/2 of the perimeter of the prosthesis. The rest of the braid of the prosthesis is endothelized. The prosthesis is excised. A frame xenoprosthesis of Kemerovo production, sheathed with epoxy-treated xenopericardium, was implanted.

The postoperative period was complicated by the development of Frederick's syndrome, on which an EX-300 in the endocardial version was implanted in VVI (demand) mode on 08/31/01. The treatment is effective, at discharge the minimum degree of activity of the process. Control Echocardiography: the function of bioprostheses is not impaired. Vegetations on prostheses are not revealed.

Follow-up examination after 9 months: minimal complaints. The activity of the inflammatory process according to laboratory data is minimal. The function of bioprostheses is adequate. There are no signs of inflammation on the echocardiography; no vegetation has been identified.

In total, in the mitral position with active infectious endocarditis, 2 frame xenoprostheses of Kemerovo production, sheathed with epoxy-treated xenopericardium, were implanted. In all cases, a positive therapeutic effect was obtained.

An example of implantation in the tricuspid position.

Patient T., 27 years old, and / b No. 3709/02. He entered the Novosibirsk Research Institute of Circulatory Pathology on July 15, 2002. He fell ill in December 2000, was treated at the place of residence for infectious endocarditis. In the same year, tricuspid malformation was diagnosed (failure). In 2001, the tricuspid valve prosthetics was performed at the Scientific Research Institute of PK using the KemKor-32 xenoprosthesis. I felt satisfactory until August 2001, when an exacerbation of infectious endocarditis occurred. Antibacterial therapy is ineffective. Since May 2002, the resumption of fever (up to 40 ° C), increased shortness of breath, decreased exercise tolerance.

At the clinic of the Scientific Research Institute of PK, the diagnosis was established: paraprosthetic thrombendocarditis, I-II art. Act. Tricuspid valve prosthesis dysfunction. The operation of the tricuspid valve prosthetics with the KemKor-32 xenoprosthesis in 2001 by the Central Bank of NK (III FC according to NYHA).

Echocardiography. TrK: shadow of a biological prosthesis, additional flotating echo signals 3.1 · 3.3 mm, 4.4 · 5.0 mm, 10.9 · 2.6 mm, eff. an area of 1.6-1.82 cm ² , a diastolic gradient of 18.6 mm Hg, regurgitation is not determined. In the cavity of the right atrium, parietal additional echo signals are visualized, passing into the projection of the fibrous ring.

The presence of prosthetic dysfunction, leading to significant hemodynamic disturbances, circulatory failure of 2 b. Art., Require correction of the defect despite the activity of infectious endocarditis 1-2 tbsp.

The operation was performed on July 18, 2002: reprosthesis of the tricuspid valve with a Kemerovo-based frame xenoprosthesis sheathed with epoxy-treated xenopericardium. On the operation: the valves of the prosthesis are gray-yellow in color, almost motionless. Closer to the free edge, on the atrial surface, are vegetations, thrombotic strata. The prosthesis is excised. On the ventricular surface of one of the valves there is a mixed thrombus of 2 · 1.5 cm. Re-prosthetics of the tricuspid valve is performed.

The postoperative period was with the activation of infectious endocarditis. The treatment is effective, at discharge the minimum degree of activity of the process. Control Echocardiography: the function of the bioprosthesis is not impaired, vegetation on the prosthesis has not been identified.

With active para-prosthetic endocarditis, 1 frame xenoprosthesis of Kemerovo production, sheathed with epoxy-treated xenopericardium, was implanted into the tricuspid position. A positive immediate therapeutic effect was obtained.

Thus, for the treatment of active para-prosthetic endocarditis of atrioventricular valves, 3 frame xenoprostheses sheathed with epoxy-treated xenopericardium were implanted (2 in the mitral position, 1 in the tricuspid position). In all cases, a positive therapeutic effect was obtained.

Claims (1)

A method of surgical correction of atopic ventricular valve paraoprosthetic endocarditis, including valve reprosthesis, characterized in that after excision of the prosthesis and antiseptic treatment of the foci of infection, a frame xenoprosthesis sheathed with an epoxy treated xenopericardium is inserted into the mitral position when the xenoprosthesis is implanted , some of which may be on gaskets, when implanting a xenoprosthesis into a tricuspid position, it is fixed in position ii anulus, the septal flap fixed separate U-shaped welds, the front flap - in the middle of a single U-shaped seam, on all other fixed continuous throughout ksenoprotez twining round seam.