RU228429U1 - Simulator for practicing skills of correction of complete atrioventricular septal defect - Google Patents

Abstract

The utility model relates to the field of medicine, cardiac surgery, namely to medical equipment, in particular to multifunctional simulators for practicing the skills of correcting a complete atrioventricular septal defect (CAVSD). The technical result consists in increasing the efficiency of practicing the skills of correcting a complete atrioventricular septal defect. This is achieved by the fact that in the claimed simulator, containing models of: atria with an atrial septal defect (ASD), ventricles of the heart with an interventricular septal defect (VSD), atrioventricular (AV) valve with subvalvular structures, vena cava, fragments of the right pulmonary artery and pulmonary trunk, according to the utility model, all elements are made of silicone poured into appropriate molds printed on a 3D printer, with subsequent gluing of the models of all parts of the heart together in accordance with the anatomical features.

Description

The utility model relates to the field of medicine, cardiac surgery, namely to medical equipment, in particular to multifunctional simulators for practicing skills in correcting a complete atrioventricular septal defect (CASD).

Complete atrioventricular septal defect (patent atrioventricular canal) is a congenital disease and is a heart defect in which there are defects (holes) in the interatrial and interventricular septa (the walls between the atria and between the ventricles of the heart), as well as clefting (separation into two parts) of the mitral and tricuspid valves of the heart.

Pediatric cardiac surgery is one of the most difficult sections of surgery, because surgeons mainly have to operate on congenital heart defects, which are very difficult to radically correct without skill and experience. Currently, there is an obvious shortage of training material adapted to simulate congenital heart defects (CHD). Therefore, having simulators in their arsenal, surgeons will be able to understand the principle and hone the skills of correcting various CHD, including practicing the skills of correcting a complete atrioventricular septal defect (CASD).

PDAVP occurs in 1 in 10,000 newborns and usually requires correction at 3-6 months of life. In the case of a balanced type, biventricular correction with patching is performed; in the case of an unbalanced type, the Fontan procedure is performed.

A simulator in the form of a silicone 3D model of the heart is known for practicing and improving methods for treating complex congenital heart defects, such as atrioventricular septal defect, including the atria and ventricles with septal defects, the superior and inferior vena cava, a fragment of the pulmonary artery, and the atrioventricular (AV) valve with cusps (Partial heart transplantation of atrioventricular valves in complete atrioventricular septal defect-simulation of techniques using silicone-molded heart models. Nabil Hussein, Joseph W. Turek, Taufiek Konrad Rajab).

However, the AV valve in this simulator does not contain a chordal apparatus. In addition, this simulator has tight shortened cusps, which does not allow practicing an operation that is most close to reality in complexity.

A simulator is known in the form of a silicone 3D model of the heart with a perimembranous type of ventricular septal defect (VSD), including the orifice and ascending part of the aorta, left atrium, left ventricle, pulmonary artery, pulmonary valve, right atrium, and right ventricle (Congenital Heart Surgery Skill Training Using Simulation Models: Not an Option but a Necessity. Shi-Joon Yoo, Nabil Hussein and David J. Barron).

This simulator also does not allow you to practice an operation that is as close to reality in complexity as possible, and, in addition, the AV valves have a dense and thickened structure, which complicates the performance of plastic surgery on such a simulator.

The objective of the utility model is to create an effective simulator for practicing the skills of correcting a complete atrioventricular septal defect, allowing one to simulate and practice an operation that is as close to reality in complexity as possible.

The technical result consists in increasing the efficiency of practicing skills for correcting a complete atrioventricular septal defect.

This is achieved by the fact that in the claimed simulator, containing models of: atria with an atrial septal defect (ASD), ventricles of the heart with an interventricular septal defect (VSD), atrioventricular (AV) valve with subvalvular structures, vena cava, fragments of the right pulmonary artery and pulmonary trunk, according to the utility model, all elements are made of silicone, poured into appropriate forms printed on a 3D printer, with subsequent gluing of models of all parts of the heart together in accordance with the anatomical features.

In addition, the claimed simulator allows practicing the correction of complications that may arise after the main stage of the operation. These include: subaortic stenosis, which occurs due to short chords that attach the anterior leaflet of the left newly formed AV valve to the crest of the septum. To correct it, its augmentation is performed (increase with a patch). Insufficiency of newly formed AV valves due to splitting of the leaflets. To eliminate it, suturing of the split or annuloplasty in its projection is performed.

The claimed utility model relates to a device, since it consists of several elements (parts) connected to each other by gluing, ensuring the constructive and functional unity of all elements of the structure, the manufacture and assembly of which is carried out at a specialized enterprise by order of a specialist.

The claimed simulator is illustrated with drawings.

Fig. 1. Schematic view of the simulator;

Fig. 2. Mold for filling the model of the ventricles of the heart with VSD and a fragment of the inferior vena cava;

Fig. 3. Form for filling the AV valve apparatus;

Fig. 4. Stencil of the cusps, chords and papillary muscles of the AV valve;

Fig. 5. Mold for filling the model of atria with ASD and a fragment of the superior vena cava;

Fig. 6. Form for filling models of fragments of the pulmonary trunk and right pulmonary artery, where:

1 - AV valve cusps, 2 - AV valve chords, 3 - papillary muscles, 4 - atria with ASD, 5 - ventricles of the heart with VSD, 6 - fragment of the superior vena cava, 7 - fragment of the inferior vena cava, 8 - pulmonary artery trunk with its right branch.

A simulator for practicing skills for correcting a complete atrioventricular septal defect is made as follows.

The molds are printed on a 3D printer, as shown in Fig. 2-6, and silicone is poured into them. After the silicone dries, all the elements are glued together according to the anatomical features.

The cusps 1 of the AV valve and the chords 2 with the papillary muscles 3 are cut out according to the template, as shown in Fig. 4, screwed in and implanted into the ventricles 5, then glued to the atria 4. Next, on the right, from the side of the inferior vena cava 7, a fragment of the pulmonary artery 8 is glued, bringing the distal end under the superior vena cava 6.

The simulator in accordance with Fig. 1 is ready for practicing the skills of correction of a complete atrioventricular septal defect.

The claimed Simulator for practicing the skills of correction of a complete atrioventricular septal defect can be manufactured industrially in the conditions of an enterprise specializing in the production of silicone products, with subsequent connection of all the specified elements by gluing and then sending to the consumer in finished form. In this case, mass consumers can be students of cardiac surgery departments of medical universities, as well as students of advanced training courses in cardiac surgery.

Example 1. Practicing skills in correcting defect plastic surgery using patches for a balanced type of complete AV septal defect.

The molds were printed on a 3D printer, as shown in Fig. 2-6, and silicone was poured in. After the silicone dried, all elements were glued together, as shown in Fig. 1, in accordance with the anatomical features.

After manufacturing the simulator, we started practicing the skills of defect correction plastic surgery using patches for a balanced type of complete AV septal defect. We open the right atrium (RA) parallel to the coronary groove. During revision of the atria and ventricles, we determine a complete AV septal defect. We perform VSD plastic surgery using a semicircular Dacron patch. We sew the patch to the septum with a continuous suture, starting from the lower central point of the VSD, continuing to its anterior upper edge. We make the last stitch through the AV valve ring into the RA cavity. Then we make the suture from below along the right side of the IVS. We make the last stitch in the RA along the AV valve ring. Using a hydrotest, we determine the suture line between the AV valve cusps with the crest of the newly formed IVS. Then we sew the AV valve cusps to the IVS with U-shaped sutures. Simultaneously, we pass stitches through the autopericardium patch. We place traction sutures on the corners of the patch and the lateral rim of the ASD. Then we tie sutures connecting the upper edge of the Dacron patch, the AV valve, and the autopericardium.

During revision of the left newly formed AV valve, we note tension of the anterior leaflet. We cut off the anterior leaflet at the base from the fibrous ring. We sew a patch of autopericardium into the formed opening with a continuous suture. An opening of the posterior leaflet split is also detected. The split is sutured with a continuous suture. Valve function is restored.

We sew the autopericardium with the ASD, starting from the top in a counterclockwise direction for half the circumference of the defect. Then we make a lower suture to bring the autopericardium patch together with the atrial wall below the coronary sinus until the defect is completely closed. We suture the RA with a continuous suture.

Example 2. Practicing skills in forming a total cavapulmonary anastomosis in case of an unbalanced type of complete AV septal defect.

The molds were printed on a 3D printer, as shown in Fig. 2-6, and silicone was poured in. After the silicone dried, all the elements were glued together, as shown in Fig. 1, in accordance with the anatomical features.

After the simulator was manufactured, we began practicing the skills of forming a total cavopulmonary anastomosis in case of an unbalanced type of complete AV septal defect. We clamp the superior vena cava (SVC) with a vascular clamp and cross it below the cannulation site at a distance of 4-5 mm upward from the cavoatrial junction. We make incisions in the upper and lower parts of the right pulmonary artery. Then we form anastomoses between the head end of the SVC and the upper wall of the right pulmonary artery, the atrial part of the SVC and the lower edge of the right pulmonary artery. Next, we cross the pulmonary trunk and suture its ends with double-row continuous sutures.

We open the RA parallel to the coronary groove. During revision of the atria and ventricles, we determine a complete defect of the AV septum. To create an intra-atrial passage connecting the vena cavae to each other, we use a PTFE patch. We sew the patch to the atrium with a continuous suture, leaving a small residual defect along the lower edge. We apply a U-shaped suture on Teflon pads to the defect. We bring the suture out through the wall of the RA and tighten it on the tourniquet. We suture the RA with a continuous suture.

Thus, the claimed simulator will be very useful for young cardiac surgeons, residents and students for practicing the skills of correcting a complete AV septal defect.

By simulating planned or equivalent procedures in advance, trainee surgeons will be able to perform their procedures on patients with a higher level of proficiency and confidence. As a result, the risk to patients associated with inadequate procedures performed by inexperienced hands can be minimized, operating room time can be reduced, and surgical outcomes can be improved. By incorporating clearly defined simulation modules into the regular curriculum, structured training can be provided in the form of an effective, thorough, and consistent curriculum that minimizes the disadvantages of accidentally encountering unexpected situations during cardiac surgery. Simulation training can also be useful in mitigating the adverse effects of unresolvable situations.

Claims (1)

A simulator for practicing skills in correcting a complete atrioventricular septal defect, containing models of atria with an atrial septal defect, ventricles with an interventricular septal defect, an atrioventricular valve with subvalvular structures, vena cava, fragments of the right pulmonary artery, pulmonary trunk, cusps, chords and papillary muscles of the AV valve, with the models made of silicone, which is poured into appropriate molds, printed on a 3D printer and glued together in accordance with anatomical features.

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