SU1225529A1 - Method of valvuloplasty of ratioventricular openings of heart - Google Patents

Description

The invention relates to medicine j specifically to cardiac surgery, and can be used in reconstructive operations on atrioventricular valves. .

The purpose of the invention is the reduction of postoperative complications by applying a patch of auto fabric. .

The method is implemented as follows.

To determine the size of the transplanted autopericardium, the width of the fibrous ring, the ant-vent valve is measured, the transverse length of the lesion; cusps, the distance between the apex of the papillary muscle and the fibrous ring, which corresponds to the length of the broken chord, the height of the papillary muscle. After measurements are taken, the affected valve leaflet is pulled into the incision of the auricle and the hooks are rigidly fixed. The rupture of the aiis chords is excised. A flap having the shape of a valve leaflet is cut from an autopericardium. The base of the flap is fixed with a continuous blanket stitch to the fibrous ring, followed by hemming of the flap edge to the flap. The apex of the flap is fixed to the lateral surface of the papillary muscle. An atraumatic prolenic thread is used for the guiding of the autopericardium. And in order to form fibrous B; an autopsy flap is taken in the form of a tape with a length corresponding to the circumference of the atrioventricular orifice, and fixed with grooves to the wall of the left atrium in the area of the fibrous ring.

Example. Patient, 24 years old. Received complaints of palpitations during exercise; violation of the rhythm of cardiac activity, reduction in working capacity.

During the clinical examination in the outpatient and according to instrumental methods of examining the heart (PCG, EchoCG, ECG, X-ray examinations of the heart in three projections), the patient was diagnosed with insufficiency of the mitral valve of stage III, atrial fibrillation, circulatory insufficiency HAC IV functional New York Cardiovascular Classification Class.

The patient was operated on. Access to the heart is via a median sternotomy. When a finger revision of the mitral valve through the eye of the left atrium was determined, it was through the mitral valve with a diameter of up to 25 mm and a height up to the base of the ear. Connect the heart-lung machine. The main stage of the operation is performed under conditions of hypothermic artificial blood circulation and pharmacological cardioplegia through the coronary arteries by puncturing the aorta below its place and by external cooling of the heart with an ice-snow mass and cold solution. Opened the left atrium nuke of the atrial cord, right.

When revision of the mitral valve: valve cusps are flexible enough, flexible, no calcification. There is a full separation of the central chords 1 in order from the anterior leaflet of the mitral valve. The diameter of the left atrioventricular orifice is 49 mm, the width of the fibrous ring is 1.9 mm, the transverse length r of the front flap is 37 mm., The back one is 9 mm. The length of the central chord 1 is; the length of the anterior cusp is 53 mm, the posterior one is 49 kb1. The height of the papilus: the frontal flap of the front flap is 23, the posterior one is 20 mm.

A hydraulic test is carried out on the closing capacity of the leaflets, of the valve, by filling in the left arm. Ludochka cardioplegic solution, followed by its external compression. The insufficiency of the mitral valve is due to prolapse of the anterior cusp into the cavity of the left atrium. The curvature is 3 central chords of the first order of the cusp. Broken chords are excised. From the pericardium, a triangular flap is cut out with a base length of 29-30 mm and a height of mm. The base of the flap is hemmed to the fibrous ring around the perimeter of the anterior cusp, uninterruptedly, with a blanket stitch, with an atraumatic proline thread. Kra flap sewn to the flap. The top of the flap is stitched to the papillary muscle. A repeated hydraulic test is performed - there is no regurgitation through the mitral valve. Los. Autokuerkarda keeps the anterior steIurka from prolabirovan in the left atrium.

After the restoration of cardiac activity, a digital revision of the mitral valve is performed on the effectiveness of the performed operation - there is no regurgitation through the valve.

The postoperative period was uneventful. At discharge, a control examination was performed - there is no noise on the mitral valve. During an EchoCG examination, the cavity of the left atrium and the left ventricle decreased by from the initial value.

Under observation were 22 patients. Postoperative period

Compiler M. Pozn to. Editor N. Tupitsa Tehred I.Popovich Proofreader A. Ferenc

2016/2

Circulation 660 Subscription

VNIIPI USSR State Committee

for inventions and discoveries 113035, Moscow, Zh-35, Raushsk nab., 4/5

Production and printing company, Uzhgorod, st. .Project, 4

these patients proceeded without complications, were discharged home 12-16 days after surgery. At follow-up examination in the long-term after surgery (6-8 months), the condition of the patients is satisfactory, able-bodied.

In the control group, 18 patients were bypassed. Postoperative mortality in the control group after prosthetics was 17%; 5 years after surgery, the overall mortality rate was 43%, where thromboembolic complications were the main cause of death.

Claims (1)

.. METHOD OF ATRI VALVULOPLASTY · bventry-cupular heart HOLES by the formation of an artificial fibrous ring and heart valves, characterized in that, in order to reduce postoperative complications, a flap from the autopericardium in the form of a valve leaf is placed on the affected leaf with the base to the fibrous ring the muscle is fixed with sutures, and to form the fibrous ring, an autopericardial flap is taken in the form of a tape with a length corresponding to the circumference of the atrioventricular opening, and fixed with sutures to the wall of the left atrium in the fibrous ring.