RU2192176C2 - Method for fixing prosthesis of aortal valve in case of damaged fibrous ring - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: the method could be used at treating the failures of aortic valve. One should resect the folds and fibrous ring of aortic valve. Catheters are introduced into coronary arteries to detect their pathway. In area of fibrous ring p- shaped sutures are intra-aortally made at autopericardial interlayers. Endocardial edges are made to be closer to restore anatomic position of fibrous ring. Ligatures are remained and put through prosthesis braiding and aortal wall and extra-aortally-located synthetic tissue along aortal perimeter. Ligatures are tied together by developing an extra-aortal supporting synthetic ring. Prosthesis is fixed. Operation is carried out under constant control for the permeability of coronary arteries. The method enables to remove the failures of aortal valve accompanied by the damage of fibrous ring. EFFECT: higher efficiency of fixation. 1 ex

Description

 The invention relates to medicine, namely to cardiac surgery, and can be used in the treatment of aortic valve defects.

 In cardiac surgery for prosthetics of the heart valves, a method of fixing the prosthesis to the fibrous ring of the valve (I) is used. With the destruction of the fibrous ring of the valve, difficulties arise in reliable fixation of the prosthesis to the destroyed tissues, which is accompanied by subsequent eruption of sutures and the appearance of paravalvular fistulas.

 The purpose of the invention is to more effectively eliminate defects of the aortic valve, accompanied by the destruction of the fibrous ring.

 The intended goal is achieved by applying intra-aortic sutures around the perimeter of the valve prosthesis with suturing to the outer wall of the aorta around the entire perimeter of the fibrous ring of the aortic valve.

 The method is as follows. After excision of the cusps and the destroyed fibrous ring of the aortic valve, the course of the coronary arteries is determined, which is achieved by introducing coronary catheters into the right and left coronary arteries, which allow subsequent identification of the valve to identify coronary arteries in the surrounding tissues.

 The second stage eliminates defects in the fibrous annulus of the valve arising from the excision of necrotic tissue by the application of intra-aortic U-shaped sutures using gaskets from the autopericardium. When tying the thread, the edges of the endocardium come closer to restore the anatomical position of the fibrous ring. The ends of the threads and needles are not cut and used in the subsequent stages of the operation.

 The third stage is the application of 15 separate U-shaped sutures along the entire perimeter of the fibrous ring of the aortic valve. Then the U-shaped sutures are passed through the braid of the prosthetic valve, the wall of the aorta and out extra-aortic. At the same time, they constantly monitor the patency of the coronary arteries. The extracted extraaortic sutures are tied on a synthetic ring around the aorta, bind them together and fix the prosthesis to the aorta, forming an extraaortic support synthetic ring. Having completed the stage of prosthesis fixation according to the specified technique, they are again convinced of the patency of the coronary arteries, the aorta is sutured and blood circulation is restored.

 Example. Patient S., 34 years old, I / B 391-98, was admitted to the NIIPK on 02.20.98. From the anamnesis it is known that he fell ill acutely after suffering pneumonia. After 1 month, a pathological noise was heard in the region of the heart, and fever persisted.

 The condition at admission is serious. Tolerance to physical activity, swelling on the legs, the liver protrudes 10 cm from under the costal arch, the borders of the heart are widened to the left. On the left edge of the sternum, protodiastolic murmur, pulsation of the carotid arteries is excessive, blood pressure 140/20 mm RT. Art.

 Radiological: pulmonary congestion, SLK 58%, enlarged left heart, aorta expanded, pulsating excessively.

 Electrocardiography revealed the presence of incomplete blockade of the left bundle branch block, left ventricular hypertrophy.

 Echocardiography: Exile fraction 0.67, contractility index 0.38, left atrium 5.5, right atrium 6.0, left ventricular CRC 6.8 left ventricular CRC 4.3. Vegetations were revealed on the valves of the aortic valve, a reverse stream of blood on the aortic valve, equal to 40% of the area of the left ventricle.

 03/15/98, the operation was performed. Median sternotomy. Standard cannulation. The aorta is dilated, pulsating excessively. Transverse aortotomy. On the cusps of the aortic valve, large vegetations, rupture of the non-coronary cusp and abscess of the fibrous ring in the projection of the coronary cusps. After excision of the necrotic tissue, a defect in the fibrous ring occurred, accounting for 60% of the perimeter of the aorta. Coronary catheters with a diameter of 3 mm were inserted into the coronary arteries to determine the course of the coronary arteries. The edges of the endocardium are brought together by separate U-shaped sutures on the autopericardial pads, then the sutures are drawn through the braid of the mechanical prosthesis, the aortic wall and synthetic tissue located ecotraaortally around the entire perimeter of the aorta, then tied and connected. The prosthesis was fixed with constant monitoring of patency of the coronary arteries. Aorta is sutured and blood circulation restored.

 As a result of intensive drug therapy, a decrease in the activation of inflammation was achieved and stabilization of blood circulation was obtained. Wound healing by primary intention.

 ECG - sinus rhythm, incomplete blockade of the left bundle branch block.

 ECHO cardioscopy-FI-0.62, IS-0.42, the size of the left atrium is 4.2, the size of the right atrium is 3.0, LFcdr 4.5, LV cfr 3.4, systolic gradient on the aortic, valve 18 mm Hg . There is no reverse discharge on the aortic valve. The method demonstrates the effectiveness of fixing the aortic valve prosthesis with a destroyed fibrous ring, allowing to prevent the development of paravalvular fistulas.

Literature
1. Cardiovascular surgery. Edited by V.I. Burakovsky, L.A. Boqueria. Moscow, 1989

Claims (1)

 A method for fixing aortic valve prostheses with a destroyed fibrous ring, including excision of the valves and necrotic tissue of the fibrous ring, implantation of the prosthesis, characterized in that after excision of the valves and the fibrous ring of the aortic valve, catheters are inserted into the coronary arteries and the coronary arteries are determined, then in the region of the fibrous ring U-shaped sutures are carried out intraaortally on autopericardial pads, bring together the edges of the endocardium and restore the anatomical position of the fibrous ring, the threads are left and oestriasis them through the braided prosthesis and the aortic wall and disposed ekstraaortalno synthetic fabrics aortic perimeter with constant monitoring of coronary patency, bind to each other, forming support ekstraaortalnoe synthetic ring and fixed prosthesis.