WO2014173046A1 - Système de guidage adaptatif pour la chirurgie d'obturation de défaut septal auriculaire percutané à l'aide d'un guide unique d'échocardiographie transthoracique - Google Patents

Système de guidage adaptatif pour la chirurgie d'obturation de défaut septal auriculaire percutané à l'aide d'un guide unique d'échocardiographie transthoracique Download PDF

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Publication number
WO2014173046A1
WO2014173046A1 PCT/CN2013/081669 CN2013081669W WO2014173046A1 WO 2014173046 A1 WO2014173046 A1 WO 2014173046A1 CN 2013081669 W CN2013081669 W CN 2013081669W WO 2014173046 A1 WO2014173046 A1 WO 2014173046A1
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WIPO (PCT)
Prior art keywords
catheter
guide wire
ultrasound
septal defect
sheath
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PCT/CN2013/081669
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English (en)
Chinese (zh)
Inventor
潘湘斌
Original Assignee
Pan Xiangbin
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Application filed by Pan Xiangbin filed Critical Pan Xiangbin
Priority to CN201380075968.4A priority Critical patent/CN105188824B/zh
Publication of WO2014173046A1 publication Critical patent/WO2014173046A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/09—Guide wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0097—Catheters; Hollow probes characterised by the hub
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/06—Body-piercing guide needles or the like
    • A61M25/0662—Guide tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/09—Guide wires
    • A61M2025/09175—Guide wires having specific characteristics at the distal tip
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0041—Catheters; Hollow probes characterised by the form of the tubing pre-formed, e.g. specially adapted to fit with the anatomy of body channels

Definitions

  • the present invention belongs to the field of medical technology, and particularly relates to a percutaneous transluminal septal defect sealing method and an adaptive guiding system thereof. Background technique
  • Atrial septal defect which is one of the most common types of congenital heart disease, is formed by residual defects in the atrial septum during embryonic development. Most of the septal defects are single-hole type, a few are porous, and very few are mesh-shaped. The gap between the rooms and the congenital heart disease is about 15%-20%, and the ratio of male to female is 1.7:1.
  • Open-chest surgery is the earliest method. It is suitable for all types of patients and saves a lot of patients' lives. However, it has shortcomings such as long surgical incision, need for extracorporeal circulation, long recovery time, and psychological and physical trauma to patients. They are very large. In order to overcome these shortcomings, there is a occlusion of percutaneous atrial septal defect, which has the advantages of small trauma and quick recovery after surgery. However, patients must be irradiated with radiation during surgery. Radiation damage may affect the organs such as bone marrow, genitals and thyroid.
  • the contrast agent used in the operation has risks such as allergies and renal failure; if life-threatening complications such as occluder detachment, cardiac perforation, and pericardial tamponade occur during the operation, emergency transfer to the surgical room is required for thoracic rescue, translocation. Time is it The key to saving the lives of patients.
  • the present invention provides a simple transthoracic ultrasound guided percutaneous intervention for atrial septal defect closure.
  • An adapted guidance system for said transthoracic ultrasound guided percutaneous interventional atrial septal defect occlusion is provided.
  • the present invention provides a novel guiding system for occlusion of a percutaneous transluminal septal defect guided by a simple transthoracic ultrasound, the guiding system comprising a catheter for adjusting the direction and controlling the diameter of the guide wire head, for facilitating ultrasound display and passage A guide wire that is missing from the room and a loading sheath that feeds the guide wire into the catheter.
  • the guide wire is divided into two parts: a guide wire body and a head portion of an integrally formed structure, the main body portion is made of 0.035 inch steel wire, and the head is in a spindle-shaped three-dimensional structure, which is woven by a high elastic nickel-titanium alloy wire. a rivet at the end of the head, the rivet having a hemispherical shape and a smooth surface;
  • the catheter is a hollow catheter suitable for inserting and smoothly sliding the guide wire, and is divided into a head and a tail according to an insertion direction of the guide wire inserted therein, and the head and the tail are respectively provided with holes for insertion of a guide wire
  • the duct includes a curved section near the head position and a straight section of the remaining portion, the curved section and the straight section are smoothly bent; the tail end of the duct is provided with a spiral Interface for connecting the loading sheath or hemostasis;
  • the loading sheath is a hollow tubular structure, and the loading sheath is provided with symmetric wing-shaped protrusions at the outer wall, the wing protrusions being disposed at a position close to the loading sheath inserted into the conduit for inserting the Fixation is achieved in the interface at the tail of the catheter.
  • the guide wire has a total length of 115-125 cm, the main body portion of the guide wire has a length of 110-124 cm, the head length is 1-5 cm, and the spindle structure of the head is at the widest point. 1-3 cm;
  • the length of the conduit is 70-80 cm, wherein the curved section is 2-8 cm long, the length of the remaining straight section is 62-78 cm, and the bending angle of the curved section and the straight section is 130- 140° ;
  • the loading sheath has a total length of 6-10 cm, and the wing protrusion is disposed at a position 1.5 to 2.5 cm near the direction in which the loading sheath is inserted into the catheter.
  • the guide wire has a total length of 120 cm
  • the main body portion of the guide wire has a length of 118 cm
  • the head has a length of 2 cm
  • the spindle structure of the head has a width of 1 cm at the widest point.
  • the length of the conduit is 75 cm, wherein the curved section is 5 cm long, the length of the remaining straight section is 70 cm, and the bending angle of the curved section and the straight section is 135°;
  • the full length is 8 cm, and the wing-like projection is disposed at a position 2 cm away from the direction in which the loading sheath is inserted into the catheter.
  • the points on the outer wall of the straight section of the catheter are marked with an order every 1 cm to record the depth of the catheter into the body.
  • the catheter and the loading sheath are divided into two models, 5F and 6F, according to the inner diameter.
  • the method for sealing the percutaneous atrial septal defect guided by the simple transthoracic ultrasound according to the present invention is a single guiding method using ultrasound, using a guiding system or an existing interventional device.
  • the invention also discloses a simple transthoracic ultrasound guided percutaneous transluminal septal defect occlusion using the guiding system described above, which specifically comprises:
  • the guide wire is pushed forward until the guide wire head reaches the tip of the catheter, but the guide wire does not extend out of the catheter, and the catheter loaded with the guide wire is delivered into the patient through the arterial sheath.
  • Ultrasound detection reveals that the catheter reaches the heart. Or after the catheter insertion depth reaches the aforementioned optimal working distance, the guide wire is pushed forward, the head of the guide wire is extended out of the catheter, and the opening is in a spindle shape. Due to the increased volume, the ultrasound can clearly and conveniently detect the guide wire.
  • the catheter guidewire under ultrasound guidance, operating the catheter guidewire, through the atrial septal defect, if the diameter of the atrial septal defect is smaller, the diameter is smaller than the widest diameter of the spindle-shaped head of the guidewire, the first half of the spindle-shaped head of the guidewire can be
  • the guide wire is fixed, the catheter is pushed forward, the posterior portion of the spindle-shaped head is retracted into the catheter, the volume of the guide wire is reduced, and the catheter and the guide wire are pushed forward together.
  • the catheter can pass through the lesion; after the catheter passes through the atrial septal defect, exit the catheter and the arterial sheath, and keep the guide wire in the left atrium; according to the diameter of the occluder, select 8 ⁇ 10F of traditional atrial septal defect closure
  • the sheath is sent to the left atrium along the guide wire, and after exiting the guide wire and the inner core, it is sent to the atrial septal defect occluder and sealed under ultrasonic monitoring; after the occluder is successfully placed, the ultrasound is carefully checked for residual shunt.
  • the mitral valve, the tricuspid valve have no reflux, and the coronary sinus has no pressure. Confirm the position and shape of the occluder. After the occlusion is successful, turn the delivery rod counterclockwise to release the occluder.
  • the long sheath is routinely pulled out and pressed to stop bleeding, and the bandage is bandaged.
  • the method further includes:
  • the invention also discloses a simple transthoracic ultrasound guided percutaneous transluminal septal defect occlusion using a multi-functional catheter and a guide wire in the prior art, comprising the following steps:
  • peripheral blood vessel ultrasound should be performed to confirm whether the guide wire is located in the femoral vein; If it is not in the femoral vein, or if the ultrasound is unclear, the skin should be cut open, and the femoral canal should be placed after the free femoral vein.
  • the catheter When the ultrasound upper catheter image disappears, the catheter is pushed forward slightly to display the catheter tip, and the catheter tip is operated through the chamber under ultrasound guidance.
  • Septal defect After the catheter passes through the atrial septal defect, insert the super-hard guide wire into the left atrium, exit the catheter and the arterial sheath; according to the diameter of the occluder, select the traditional atrial septal defect occlusion sheath of 8 ⁇ 10F, along the
  • the super-hard guide wire is sent to the left atrium, and the left atrium is repeatedly scanned by ultrasound to show the tip end of the delivery sheath, which cannot be inserted too deeply; if the delivery sheath is inserted After the guide wire and the inner core are withdrawn, the delivery sheath will be dislodged into the right atrium, and the above steps need to be repeated; after the delivery sheath is sent to the left atrium, it is sent to the atrial septal defect occluder through the delivery sheath, and is performed under ultrasonic testing.
  • the ultrasound was carefully examined for residual shunt, mitral and tricuspid regurgitation, and coronary sinus pressure. Confirm the position and shape of the occluder. After the occlusion is successful, turn the delivery rod counterclockwise to release the occluder. The long sheath is routinely pulled out and pressed to stop bleeding, and the bandage is bandaged.
  • the method further includes:
  • the indications and prohibition of the percutaneous transluminal septal defect in the simple transthoracic ultrasound guided by the present invention The symptoms include:
  • Indications Age 2 years; body weight 10 kg, atrial septal defect with a 5 mm diameter and a right heart volume load; the distance from the margin of the defect to the coronary sinus, superior and inferior vena cava, and pulmonary veins is 5 ⁇ , The distance to the atrioventricular valve is 7 mm; the diameter of the septum is selected > the diameter of the left atrium side of the occluder selected. Contraindications: primary hole and sinus atrial septal defect; endocarditis and hemorrhagic disease; thrombus in the place of occluder, venous thrombosis at the catheter insertion; severe pulmonary hypertension leading to right-to-left shunt, Combine diseases that require surgical treatment.
  • the simple transthoracic ultrasound-guided percutaneous atrial septal defect sealing method utilizes ultrasound as the sole guiding medium, which not only overcomes the problem of radiation and contrast agent damage caused by radiation as a guiding medium in the prior art, and truly does not Open, non-radiative, non-contrast agent for atrial septal defect; if the puncture is difficult, or if the guide wire is located in the femoral vein, the surgeon can open the skin, free the femoral vein, and insert the arterial sheath; and once the closure fails or appears When life-threatening complications such as occluder shedding, cardiac perforation, and pericardial tamponade, the surgeon can immediately open the chest for open heart surgery to maximize patient safety.
  • This technology can be completed in a general surgical operating room, eliminating the need for expensive large-scale radiation equipment and facilitating widespread application.
  • the technique does not require endotracheal intubation, and patients who are treated with the treatment can perform the operation under local anesthesia. Children who do not cooperate with the treatment can complete the operation under basic anesthesia;
  • the present invention discloses a simple transthoracic ultrasound guided percutaneous transluminal septal defect occlusion that can be achieved by using a conventional multi-functional catheter, although the method requires more attention during the operation, especially Need to repeat the ultrasound to judge, the surgeon's technology and experience have certain requirements, but it can still overcome the radiation and contrast agent damage caused by the ray-guided occlusion technique in the prior art, and has high safety guarantee. ;
  • the novel guiding system of the present invention is designed as an open spindle-shaped three-dimensional structure due to the insertion portion of the guide wire, due to the volume. Increase, ultrasound can clearly and conveniently explore the AC segment.
  • the AB segment can be sent to the lesion, the guide wire is fixed, the catheter is pushed forward, and the BC segment or even part of the AB segment is retracted into the catheter, catheter and guide.
  • the silk is pushed forward together, the ultrasound can be accurately guided through the atrial septal defect;
  • FIG. 2 is a schematic structural view of a catheter in the guiding system of the present invention.
  • the guiding system of the present invention includes a catheter for adjusting the direction and controlling the diameter of the guidewire head, a guidewire for facilitating ultrasound display and passage through the atrium, and a loading sheath for feeding the guidewire into the catheter.
  • the guide wire is divided into a main body of the guide wire and a head portion of the integrally formed structure, and has a total length of 115 to 125 cm, and preferably 120 cm.
  • the main body portion (CD segment) of the guide wire is made of 0.035 inch steel wire and has a length of 110-124 cm, and preferably 118 cm;
  • the head (AC segment) has a spindle-shaped three-dimensional structure, and is made of high elasticity nickel.
  • a telescoping structure woven from a titanium alloy wire having a length of 1-5 cm, and preferably 2 cm, the widest part (BE segment) of the spindle-shaped structure of the head being 1-3 cm, and preferably 1
  • the centimeter is provided with a rivet at the end point (point A) of the head, the rivet being hemispherical and having a smooth surface.
  • the catheter is a hollow catheter suitable for inserting and smoothly sliding the guide wire, and is divided into a head and a tail according to a direction in which the guide wire inserted therein is inserted, and the head and the tail are respectively
  • a hole is provided for insertion and insertion of the guide wire, and the catheter is conventionally divided into two models of 5F and 6F according to the inner diameter.
  • the duct includes a curved section (FG section) near the head position and a straight section (GH section) of the remaining portion, and the bending section and the straight section have a bending angle of 130-140° and preferably 135 °, the total length of the conduit is 70-80 cm, and preferably 75 cm, wherein the curved section is 2-8 cm long, and preferably 5 cm, and the remaining straight section has a length of 62-78 cm, and preferably 70 cm.
  • the catheter's tail end is provided with a screw interface for attaching the loading sheath or hemostasis.
  • the points on the outer wall of the straight section of the catheter are marked with Arabic numerals every 1 cm in order to mark the depth of the catheter into the body.
  • the loading sheath is a hollow tubular structure, which is conventionally divided into two models according to the inner diameter of 5F and 6F.
  • the loading sheath is provided with symmetrical wing-like protrusions at the outer wall for facilitating the fixing sheath Tube and catheter.
  • the loading sheath has a total length of 6-10 cm, and preferably 8 cm (IK segment), and the wing protrusion is disposed at a position 1.5 to 2.5 cm and preferably 2 cm near the direction in which the loading sheath is inserted into the catheter (IJ segment) ), for inserting into the interface at the tail of the catheter to achieve fixation.
  • the distance from the third intercostal space of the patient's sternum to the ipsilateral femoral vein puncture point is measured first, which is the optimal working distance of the system.
  • the head of the guide wire, that is, the AC segment, is loaded into the sheath, and the IJ segment of the loading sheath is inserted into the tail of the catheter.
  • the guide wire is pushed forward until point A reaches point F, ie the guide wire head reaches the tip of the catheter, but the guide wire does not extend out of the catheter.
  • the catheter loaded with the guide wire is delivered into the patient through the arterial sheath.
  • the guide wire is pushed forward, and the AC segment is extended out of the catheter, AC.
  • the opening is in the shape of a spindle. Due to the increased volume, the ultrasound can clearly and conveniently probe the AC segment. Under ultrasound guidance, the catheter guidewire is manipulated through the lesion.
  • the AB segment can be sent over the lesion, the guide wire is fixed, the catheter is pushed forward, and the BC segment or even part of the AB segment is retracted into the catheter.
  • the guide wires are pushed forward together to pass through the atrial septal defect.
  • the new guiding system can exit the guide wire (AD) after passing through the atrial septal defect, insert a 0.035 super-hard guide wire along the catheter (FH), exit the catheter (FH), and insert the atrial septal defect along the super-hard guide wire.
  • the delivery sheath of the device is sent to the occluder along the sheath for occlusion treatment.
  • the novel guiding system for occluding the percutaneous transluminal septal defect guided by simple transthoracic ultrasound includes a catheter for adjusting the direction and controlling the diameter of the guide wire head, facilitating the ultrasound display and passing through the room. The missing guide wire and the loading sheath that feeds the guide wire into the catheter.
  • the guide wire has a total length of 120 cm, wherein the main body portion has a length of 118 cm and a head portion of 2 cm, and has a spindle-shaped three-dimensional structure and a maximum width of 1 cm, and is provided at the end point (point A) of the head portion.
  • rivets which are hemispherical and have a smooth surface.
  • the catheter has a total length of 75 cm and includes a curved section 5 cm long near the head position. And the remaining portion of the straight section is 70 cm long, and the bending angle of the curved section and the straight section is 135 °.
  • the tail end of the catheter is provided with a screw interface for connecting the loading sheath or the hemostasis.
  • the points on the outer wall of the straight section of the catheter are marked with Arabic numerals every 1 cm order to facilitate marking the depth of the catheter into the body.
  • the loading sheath is a hollow tubular structure, and symmetric wing-shaped protrusions are arranged at the outer wall to facilitate fixing the sheath tube and the catheter.
  • the loading sheath has a total length of 8 cm, and the wing-like projection is disposed at a position 2 cm from the direction in which the loading sheath is inserted into the catheter for insertion into the joint at the tail of the catheter to achieve fixation.
  • the novel guiding system for occluding the percutaneous transluminal septal defect guided by simple transthoracic ultrasound includes a catheter for adjusting the direction and controlling the diameter of the guide wire head, facilitating the ultrasound display and passing through the room. The missing guide wire and the loading sheath that feeds the guide wire into the catheter.
  • the guide wire has a total length of 115 cm, wherein the main body portion is 110 cm long and the head is 5 cm long, and has a spindle-shaped three-dimensional structure and a maximum width of 3 cm at the end point (point A) of the head. Rivets are provided, the rivets being hemispherical and having a smooth surface.
  • the full length of the catheter was 70 cm, including a curved section 8 cm long near the head position, and the remaining straight section was 62 cm long, and the curved section and the straight section were bent at an angle of 130°.
  • the tail end of the catheter is provided with a screw interface for connecting the loading sheath or the hemostasis.
  • the points on the outer wall of the straight section of the catheter are marked with Arabic numerals every 1 cm in order to mark the depth of the catheter into the body.
  • the loading sheath is a hollow tubular structure, and symmetric wing-shaped protrusions are arranged at the outer wall to facilitate fixing the sheath tube and the catheter.
  • the loading sheath has a total length of 6 cm, and the wing-like projection is disposed at a position 1.5 cm away from the direction in which the loading sheath is inserted into the catheter for insertion into the interface at the tail of the catheter for fixation.
  • the novel guiding system includes a catheter for adjusting the direction and controlling the diameter of the guidewire head, a guidewire for facilitating ultrasound display and passage through the atrium, and a loading sheath for feeding the guidewire into the catheter.
  • the guide wire has a total length of 125 cm, wherein the main body portion is 124 cm long and the head is 1 cm long, and has a spindle-shaped three-dimensional structure and a maximum width of 2 cm at the end point (point A) of the head. Rivets are provided, the rivets being hemispherical and having a smooth surface.
  • the full length of the catheter was 80 cm, including a curved section 2 cm long near the head position, and the remaining straight section was 78 cm long, and the curved section and the straight section were bent at an angle of 140 °.
  • the tail end of the catheter is provided with a screw interface for connecting the loading sheath or the hemostasis.
  • the points on the outer wall of the straight section of the catheter are marked with Arabic numerals every 1 cm in order to mark the depth of the catheter into the body.
  • the loading sheath is a hollow tubular structure, and symmetric wing-shaped protrusions are arranged at the outer wall to facilitate fixing the sheath tube and the catheter.
  • the loading sheath has a total length of 10 cm, and the wing-like projection is disposed at a position 2.5 cm from the direction in which the loading sheath is inserted into the catheter for insertion into the interface at the tail of the catheter to achieve fixation.
  • the method for sealing the percutaneous atrial septal defect guided by the simple transthoracic ultrasound according to the present invention is a single guiding method using ultrasound, using a guiding system or an existing interventional device.
  • the simple transthoracic ultrasound guided percutaneous transluminal septal occlusion is performed by the guiding system in the first embodiment, and the specific steps include:
  • the distance from the third intercostal space of the patient's sternum to the puncture point of the femoral vein is measured, which is the optimal working distance of the guiding system.
  • the guidewire guidewire is loaded into the sheath, the guidewire is advanced into the catheter through the loading sheath, and the guidewire is pushed forward until the guidewire head reaches the catheter tip, but the guidewire does not extend out of the catheter.
  • the catheter loaded with the guide wire is delivered into the patient through the arterial sheath. After the ultrasonic examination detects that the catheter reaches the heart, or after the catheter insertion depth reaches the optimal working distance, the guide wire is pushed forward to extend the head of the guide wire.
  • the catheter is opened and has a spindle shape. Due to the increased volume, the ultrasound can clearly and conveniently probe the head of the guide wire. Under ultrasound guidance, the catheter guidewire is operated through the atrial septal defect. If the diameter of the atrial septal defect is smaller and the diameter is smaller than the widest diameter (1 cm) of the spindle-shaped head of the guide wire, the first half of the spindle-shaped head of the guide wire can be sent through the atrial septal defect, the guide wire is fixed, and the catheter is oriented. Before the push, the rear portion of the guide wire spindle-shaped head is retracted into the catheter, and the guide wire head is reduced in volume, and the catheter and the guide wire are pushed forward together to pass through the lesion.
  • the catheter and the arterial sheath are withdrawn, and the guide wire is located in the left atrium. Since the guide wire is spindle-shaped and large in volume, the ultrasound can clearly show the depth of insertion of the guide wire into the left atrium.
  • the silk head has a large surface area, it is not easy to break the left atrium wall, and it is not easy to get out of the atrial septal defect into the right atrium.
  • the traditional atrial septal defect occlusion sheath of 8 ⁇ 10F is selected, sent along the guide wire to the left atrium, the guide wire and the inner core are withdrawn, and the atrial septal defect occluder is sent to the ultrasound. Blocking under monitoring;
  • the ultrasound was carefully examined for residual shunt, mitral and tricuspid regurgitation, and coronary sinus pressure. Confirm the position and shape of the occluder. After the occlusion is successful, turn the delivery rod counterclockwise to release the occluder. Routinely pull out the long sheath and compress the hemostasis, and bandage the pressure bandage;
  • Example 5 The simple transthoracic ultrasound guided percutaneous transluminal septal occlusion is performed by a multi-functional catheter guiding system used in conventional ray guiding in the prior art, and the specific steps include:
  • the ultrasound can not accurately display the catheter guide.
  • the position of the silk head after the catheter is delivered into the body to reach the marked point, the ultrasound shows the inferior vena cava liver segment.
  • the catheter is pushed forward slightly, and the ultrasound is displayed in a four-chamber heart or a short axis of the aorta.
  • the septal defect, the guide wire is removed, and the multi-functional catheter is rotated.
  • the catheter image appears on the ultrasound image, the fixed catheter stops rotating, and the catheter is slowly withdrawn.
  • the catheter When the ultrasound upper catheter image disappears, the catheter is pushed forward to display the catheter. At the head end, the catheter tip is operated through the atrial septal defect under ultrasound guidance. After the catheter passes through the atrial septal defect, a super-hard guide wire is inserted into the left atrium, and the catheter and the arterial sheath are withdrawn. This step requires great care. Because the ultrasound scans with the cut surface, it is difficult to show the depth of the super-hard guide wire inserted into the left atrium. It is inserted too deeply, and it is easy to cause the left atrial perforation, rupture or guide wire to enter the left ventricle, and damage the mitral valve. The insertion is too shallow, the guide wire is easy to get out of the room when the sheath is delivered.
  • the ultrasound should repeatedly scan the left atrium to determine the depth of insertion of the superhard guide wire.
  • 8 ⁇ 10F of the traditional atrial septal defect occlusion sheath is delivered to the left atrium along the super-hard guide wire. This process also requires great care. It is difficult to show the delivery sheath inserted into the left atrium due to ultrasound. The depth of the delivery sheath is hard. If the insertion is too deep, it is easy to pierce the left atrium wall. Therefore, the ultrasound should repeatedly scan the left atrium to show the delivery sheath. The head end can't be inserted too deep.
  • the ultrasound needs to repeatedly scan the left atrium to show the insertion position of the delivery sheath tip end. After the delivery sheath is sent to the left atrium, it is sent to the atrial septal defect occluder through the delivery sheath, and is sealed under ultrasonic detection;
  • the ultrasound was carefully examined for residual shunt, mitral and tricuspid regurgitation, and coronary sinus pressure. Confirm the position and shape of the occluder. After the occlusion is successful, turn the delivery rod counterclockwise to release the occluder. Routinely pull out the long sheath and compress the hemostasis, and bandage the pressure bandage;

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Abstract

La présente invention concerne un procédé d'obturation de défaut septal auriculaire percutané à l'aide d'un guide unique d'échocardiographie transthoracique et un système de guidage de traitement adaptatif associé. Le système de guidage comprend : un cathéter (FH), un fil-guide (AD), et une gaine de charge (IK). Le fil-guide (AD) est conçu pour faciliter l'affichage ultrasonique et passe au travers d'un défaut septal auriculaire, et comprend un corps principal (CD) fabriqué en fil d'acier et une tête fusiforme (AC) tissée à partir d'un fil en nickel-titane extrêmement élastique, et un rivet est disposé sur la partie supérieure (A) de la tête (AC). Le cathéter (FH) est destiné à être utilisé pour régler une direction et réguler un diamètre de la tête (AC) du fil-guide, et est un cathéter creux. Le cathéter (FH) présente une tête et une partie arrière, et un orifice est disposé sur la tête et sur la partie arrière et est inséré en son sein par le fil-guide (AD). Le cathéter (FH) comprend un segment de pliage (FG) à proximité de la tête et un segment de ligne droite (GH) à proximité des autres parties, et un pliage régulier se produit entre le segment de pliage (FG) et le segment de ligne droite (GH) formant un angle entre eux. Une interface hélicoïdale est disposée sur la partie arrière du cathéter. La gaine de charge (IK) est destinée à être utilisée pour envoyer le fil-guide (AD) vers le cathéter (FH), et est une structure tabulaire creuse. Des protubérances symétriques en forme d'aile sont disposées sur une paroi externe de la gaine de charge (IK).
PCT/CN2013/081669 2013-04-25 2013-08-16 Système de guidage adaptatif pour la chirurgie d'obturation de défaut septal auriculaire percutané à l'aide d'un guide unique d'échocardiographie transthoracique WO2014173046A1 (fr)

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CN2013202144751U CN203169800U (zh) 2013-04-25 2013-04-25 一种治疗引导装置

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CN108523940A (zh) * 2017-03-02 2018-09-14 潘湘斌 一种用于超声引导经皮介入治疗的抓捕器
CN111513773B (zh) * 2020-03-30 2022-01-14 北京大学深圳研究生院 可回收的心室隔离装置、回收装置及系统
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