RU51866U1 - UNIVERSAL VALVE CONDITIONING - Google Patents

Abstract

The invention relates to cardiac surgery and relates to reconstructive surgery of the exit tract, both left and right ventricle. The purpose of the utility model is to create a universal valve-containing conduit from synthetic material that does not have negative properties of biological tissue or mechanical prosthetic valves, as well as the possibility of its use in reconstructing the outflow paths of both the left and right parts of the heart (this is its universality) . New is that the tubular body of a universal valve-containing conduit is formed by three modules of the same type, each of which consists of external and internal module elements made of synthetic material, while the shape and size of the external module element corresponds to the shape and size of the universal sinus of the frameless aortic root prosthesis with two 1/2 subcommissural space and 1/3 of the fibrous base of the frameless prosthesis of the aortic root, made of their synthetic material with a thickness of 0.6-1.0 mm, the side walls of the external elements of the modules are rigidly interconnected, forming a tubular hollow, volumetric body with characteristic protrusions, in addition, the internal element of the module is hemmed to the inner wall of the external element of the module along the line corresponding to the line of natural attachment of the universal leaf to the line of the fibrous ring and has the thickness is 0.1-0.3 mm, and synthetic vascular prostheses with a diameter of 22-26 mm and a width of 25 mm to the lower end and a diameter of 26 mm and a length are rigidly fixed to the lower and upper ends of the tubular body oh 100 mm to the upper end, the connection of all elements of the universal valved conduit effected by crosslinking.

Description

The invention relates to cardiac surgery and relates to reconstructive surgery of the exit tract, both left and right ventricle.

In its anatomical structure, the aortic root, which is the outlet of the left ventricle, is very similar to the pulmonary valve, i.e. places of the output department of the pulmonary artery. They have the same anatomical structures (valves, salsa of Valsalva), which are equally related to each other.

Known valve-containing conduit used in prosthetics of the aortic valve and ascending aorta, as well as valve-containing prosthesis used in reconstruction of the outflow tract of the right sections, with atresia of the pulmonary artery. When prosthetics of the aortic valve and ascending aorta, i.e. when reconstructing the outflow paths of the left ventricle, a valve-containing conduit is used, which is a vascular prosthesis hermetically connected to a mechanical valve prosthesis at one of the ends (Carbo-Seal Ascending Aortic Prosthesis, Mezhinzh).

The disadvantage of these conduits is the lifetime intake of anticoagulant drugs associated with mechanical valves, its possible thrombosis, as well as bleeding, as complications of anticoagulant therapy.

When reconstructing the outflow paths of the right ventricle, an extracardial valve-containing conduit is used, consisting of a xenopericardial tubular body with a biological valve located inside it, including three pairs of sines and valves, so that the tube is both proximal and distal to the valve (see RU 2202991, A 61 F 2/24, 2001).

The disadvantage of this conduit is the disadvantages of biological tissue: possible degeneration of the conduit and the biological valve with

the development of its stenosis or insufficiency, which requires repeated operations to replace them, the high cost of their procurement and manufacture, as well as a limited shelf life.

The utility model is based on the task of creating a universal valve-containing conduit from a synthetic material that does not have negative properties of biological tissue and mechanical valve prostheses, and the possibility of its use in reconstructing the outflow paths of both the left and right parts of the heart.

This goal is achieved by the fact that in a universal valve-containing conduit containing a tubular body with ends, including sines and valves, the tubular body is made of synthetic material volume and hollow with characteristic protrusions, which are formed by three modules of the same type, each of which consists of an external (NEM) and internal module elements (VEM), while the shape and size of the NEM corresponds to the shape and size of the universal sinus of the aortic root with two c subcommissural spaces and 1/3 of the fibrous base aortic root thickness 0.6-1.0 mm, which also corresponds to the shape and size of the same elements of the natural human aortic root. The walls of the three NEM are rigidly interconnected. The shape and size of the VEM corresponds to the shape and size of the universal leaflet and is as close as possible to the shape and size of the leaflets of the human aortic root. A VEM having a thickness of 0.1-0.3 mm is attached to the inner wall of the NEM along a line corresponding to the line of natural attachment of the universal leaf to the fibrous half moon, which corresponds to the line displaying the shape of the universal sine on the inner wall of the NEM. Synthetic vascular prostheses with a diameter of 22-26 mm and a width of 25 mm to the lower end and a diameter of 26 mm and a length of 100 mm to the upper end are rigidly fixed to the lower and upper ends of the tubular body. The connection of the modules and elements of the modules between themselves is carried out by stitching, thus, the claimed

universal valve-containing conduit meets the criteria of the invention of "novelty."

Comparison of the claimed universal valve-containing conduit with the known ones shows that the biological material is replaced with a synthetic one, and the mechanical valve prosthesis is replaced with a synthetic prosthesis and universal forms of the valve leaflet and sinuses of the aortic root are found, with which it is only possible to construct a frameless prosthesis of the aortic root, which eliminates biological degeneration tissue and from problems associated with a mechanical valve prosthesis.

The universal valve-containing conduit can be used in the reconstruction of the outflow paths of both the left and right parts of the heart. This is its universality.

The essence of the utility model is illustrated by drawings:

Figure 1 - General view of a frameless prosthesis of the aortic root

Figure 2 - the outer element of the module (NEM)

Figure 3 - the internal element of the module (VEM) -form of the universal leaf

Figure 4 - the shape of the universal sine

Figure 5 is a General view of a universal valve-containing conduit

Universal valve-containing conduit is a tubular body (Fig. 5), in the middle part of which there is a frameless prosthesis of the aortic root 1 (Figs. 1, 5) with characteristic protrusions, formed by three modules of the same type, each of which consists of two elements: external (Fig. .2) and internal (figure 3). The external element of the module is made in the form of a rectangle 2 (Fig. 2) of synthetic material with a thickness of 0.6-1.0 mm with an internal marking line 3 (Fig. 2), which is the line of the fibrous ring, i.e. the line of natural attachment of the sash and it is applied in the form of a universal sine 4 (figure 4). The lower point 5 (figure 2) of the internal line

marking 3 (figure 2) is located at a distance of 5 mm from the lower edge 6 (figure 2) of rectangle 2 (figure 2). The extreme lateral point 7 (figure 2), the internal marking line 3 (figure 2), is located at a distance of 2 mm from the side edge 8 (figure 2), rectangle 2 (figure 2). The rectangular part 9 (FIG. 2), rectangle 2 (FIG. 2), which is below the internal marking line 3 (FIG. 2), is 1/3 of the fibrous base 10 (FIG. 1) of the frameless prosthesis of the aortic root 1 (FIG. one). The remaining part of rectangle 2 (FIG. 2), under the internal marking line 3 (FIG. 2) is two centners (half) 11 (FIG. 2) of the subcommissural space 12 (FIG. 1) and two centners (half) 13 (FIG. 2) commission 14 (figure 1).

The internal element of the module is made in the form of a universal leaf 15 (Fig. 3) of a synthetic material with a thickness of 0.1-0.3 mm.

The part of the universal valve-containing conduit (Fig. 5) located above the frameless prosthesis of the aortic root 1 (Fig. 5) is made of a synthetic vascular prosthesis 16 (Fig. 5) with a diameter of 26 mm and a length of 100 mm, and the part of the universal valve-containing conduit that is below the frameless the aortic root prosthesis 1 (Fig. 5) is made of a synthetic vascular prosthesis 17 (Fig. 5) with a diameter of 22-26 mm and a length of 25 mm.

Assembly of the same type of modules of a frameless prosthesis of the aortic root.

We impose the inner element of the module (Fig. 3) on the outer element of the module (Fig. 2) and connect them by stitching using synthetic threads. We sew in such a way that points 5 (figure 2) and 18 (figure 3) are aligned with each other; 19 (FIG. 2) and 20 (FIG. 3); 21 (FIG. 2) and 22 (FIG. 3). The internal element of the module (Fig. 3) is connected to the outer (Fig. 2) along the internal marking line 3 (Fig. 2), starting from the lowest point 5 (Fig. 2), which should correspond to the lowest point 18 (Fig. 3) ) universal casement 15.

Then we proceed to the assembly of a frameless prosthesis of the aortic root from three modules of the same type.

We combine two modules so that the internal element of the module (Fig. 3) is inside. We sew the modules together along the outer edge 8 (Fig. 2) so as to combine points 19, 20 with points 21, 22 and points 23, 24 with points 25, 26, respectively, of two stitched modules, i.e. points 19, 20 and 23, 24 of one module must correspond to points 21, 22 and 25, 26 of the second module. Thus, a commissure 14 is formed (Fig. 1). Next, the modules are stitched along the line of points 19, 27 (figure 2) of one module corresponding to the line of points 21, 28 of the second module (figure 2).

Similarly, the edges of the first and third and second and third modules of the same type are stitched together. Next is the formation of a universal valve-containing conduit.

The remnants of the external elements of the modules are cut off along the line of points 27 (Fig. 2), which will be the upper edge of the connected modules 29 (Figs. 1, 5) and corresponds to 1/3 of the sinotubular ridge 29 (Figs. 1, 5) - the upper end 29 (Figs. .fifteen). To the lower edge of the formed frameless aortic root 1 (Fig. 1), i.e. to the lower end 30 (Figs. 1, 5), a vascular synthetic prosthesis 17 (Fig. 5) is hemmed with a diameter of 22-26 mm and a width of 25 mm, starting with three fixing sutures, connecting the lower points of the joints of the modules 31 (Figs. 1, 5 ) with three points located on the vascular prosthesis 17 (figure 5) at an equal distance from each other. Hemming of every third goes from the junction of module 31 (Figs. 1, 5) to the center from two sides, taking into account the difference in lengths of the objects to be sewn together.

Similarly, to the upper edge of the connected modules 29 (Figs. 1, 5), i.e. a synthetic vascular prosthesis 16 (Fig. 5) with a diameter of 26 mm is hemmed to the upper end 29 (Figs. 1, 5), starting with three fixing sutures connecting the upper points of the joints of the modules 32 (Figs. 1, 5) and three points on the synthetic vascular the prosthesis 16 (figure 5) located at an equal distance from each other. The length of the upper vascular synthetic prosthesis 16 (Fig. 5) is 100 mm.

The result is a tubular hollow volumetric body with three characteristic protrusions 33 (Figs. 1, 5) corresponding to the location of the frameless prosthesis of the aortic root 1 (Figs. 1, 5).

The universal valve-containing conduit is completely made of synthetic material, and all connections are made with synthetic thread.

The use of synthetic material, which has proven itself in various positions of the cardiovascular system (vascular prostheses, patches during reconstructive operations inside the heart), avoids the calcification of a universal valve-containing conduit and the problems characteristic of mechanical valve prostheses.

The use of the forms of the universal valve and the universal sinus, as well as the modular approach to create a frameless prosthesis of the aortic root, made it possible to construct a symmetrical prosthesis of the aortic root, which in its form was as close as possible to the shape of the natural aortic root of a person. The maximally approximate form of the aortic root allows one to count on the hemodynamic characteristics of a given prosthesis of the aortic root close to the work of the human aortic root.

Despite the similarity of the forms of the frameless prosthesis of the aortic root and the universal valve-containing conduit, the fundamental difference is the presence of synthetic vascular prostheses of a certain length, which allows not only prosthetics of the aortic root or valve of the pulmonary artery (which is also possible with the frameless prosthesis of the aortic root), but also due to the lower part of the conduit, reconstruction of the final sections and the left and right ventricles is performed, and due to the long upper part, prosthetics as an ascending aorta are possible (100 m) and a pulmonary trunk.

Claims (1)

A universal valve-containing conduit containing a tubular body with ends, including sines and sashes, characterized in that the tubular body is formed by three modules of the same type, each of which consists of external and internal module elements made of synthetic material, while the shape and size of the external module element corresponds to the shape and size of the universal sinus of the frameless prosthesis of the aortic root with two 1/2 subcommissural spaces and 1/3 of the fibrous base of the frameless root prosthesis a mouths made of synthetic material with a thickness of 0.6-1.0 mm, while the side walls of the outer elements of the modules are rigidly interconnected, forming a tubular hollow, volumetric body with characteristic protrusions, in addition, the inner element of the module is hemmed to the inner wall of the outer element of the module along the line corresponding to the line of natural attachment of the universal leaflet to the line of the fibrous ring and has a thickness of 0.1-0.3 mm, and synthetic vascular prostheses of a diameter are rigidly fixed to the lower and upper ends of the tubular body trom 22-26 mm and a width of 25 mm to the lower end and a diameter of 26 mm and a length of 100 mm to the upper end, while all elements of the universal valve-containing conduit were connected by stitching.