【作者】 赵晶；

【导师】 王辉山；

【作者基本信息】 辽宁医学院 ， 外科学， 2011， 硕士

【摘要】 目的自从1955年Lillehei等首次报道应用跨瓣环右心室流出道补片加宽治疗右室流出道狭窄,1963年Klinner及其同事应用无瓣管道重建右室流出道治疗法洛四联症,1964年Rasteli应用无瓣膜的自体心包管作为右室肺动脉管道治疗肺动脉闭锁以来,人们对应用心外管道行右室流出道(RV0T)重建应用于一系列右室-肺动脉连续性缺失的复杂性心脏病人有了新的认识。本研究主要是以PRECLUDE心包膜为瓣膜材料、Gore-Tex人造血管为血管材料制作腔窦成形的右心带瓣管道,统一制作工艺及流程并应用于临床,观察中远期效果。材料与方法1.采用高温试验箱调节温度,空气压缩机调节压力,确定Gore-Tex人造血管成形所需最适温度、压力及作用时间。在将PRECLUDE心包膜裁剪成符合腔窦大小的瓣膜,采用连续缝合,人工缝制于腔窦上。2.应用制作的腔窦成形带瓣管道在普通家猪身上行右室流出道重建术,术中关胸前用测压延长管测肺动脉压力及右心室压力,术中术后采用监护仪记录主动脉压力,比较术前与术后肺动脉收缩压、肺动脉收缩压/主动脉收缩压及右心室—肺动脉压力差,并于术后定期行心脏彩超检查,观察腔窦成形带瓣管道内瓣膜启闭情况。结果1.因我们实验要求窦深与Gore-Tex人造血管管道直径比约为1:4。故温度选择最适温度180℃,时间为30分钟,压力确定为100kpa,腔窦成形稳定,结果满意。2.动物实验:压力测定:术前肺动脉收缩压22.00±3.61,术后肺动脉收缩压23.00±3.39,0.2<P<0.4;术前肺动脉收缩压/主动脉收缩压0.28±0.01,术后0.29±0.01,0.1<P<0.2;术前右心室—肺动脉压力差4.00±2.24,术后4.20±2.59,P>0.5;术前与术后比较各项指标均尚不能认为术前与术后差异有统计学意义。3.术后一周心脏彩超检查:肺动脉瓣无反流1例,微量反流3例,轻度反流1例,中重度反流0例,瓣膜启闭良好。术后1、3、6个月肺动脉瓣反流情况均为无反流1例,微量反流4例,轻度反流0例,中重度反流0例,瓣膜启闭良好。结论1.经过反复实验发现,以PRECLUDE心包膜为瓣膜材料、Gore-Tex血管为血管材料制作腔窦成形的右心带瓣管道的制作工艺:采用空气压缩机持续加压,压力维持在100kpa,同时用高温试验箱加热Gore-Tex血管至180℃,持续30分钟,取得满意效果。2.以PRECLUDE心包膜为瓣膜材料、Gore-Tex人造血管为血管材料制作腔窦成形的右心带瓣管道,用于右心室流出道重建手术具有良好的发展前景。更多还原

【Abstract】 ObjectiveSince 1955, Lillehei first reported the use of cross valve ring patching in the correction of the right ventricular outflow tract (RVOT) stenosis, in 1963, Klinner and his colleagues reconstructed the RVOT with valveless conduit in the correction of the Tetralogy of Fallot defects, and in 1964, Rasteli corrected pulmonary atresia by reconstructing the right ventricular-pulmonary outflow tract using valveless conduit made by autologous pericardium, people have got a better recognition of the use of extracardiac conduit for the reconstruction of the RVOT in the corrections of series of complex right ventricular-pulmonary arterial defects. In this study, we mainly construct right ventricular valved conduits using PRECLUDE pericardium and Gore-Tex artificial vessel as valve and vessel material respectively. Our aim is to standardize the producing craft and the process flow, and also to observe the medium- and long-term effects in clinical application.Materials and methods1. Adjust the temperature by high temperature chamber, accommodate the pressure by air compressor, to determine the required optimum forming temperature, pressure and time. Cut the PRECLUDE into the valve that fit to the sinus cavity, and seam it to the sinus cavity by using continuous suture.2. Pigs were operated with the blood vessel that we made. right ventricular systolic pressure and pulmonary artery pressure were measured before closing the thoracic incisions, arteriae aorta pressure was recorded by invigilator when operating and postoperative.To compare the pulmonary artery systolic pressure, pulmonary artery systolic pressure / arteriae aorta systolic pressure and right ventricular - pulmonary arterial pressure difference between preoperative and postoperative,to check the pigs regularity for reviewing the funct of the valve that we made.Results1. The proportionality of Sinus Depth and Ridge Radius that we need is 1:4, so the pressure maintained at 100kpa, sustained pressing; Temperature would be 180℃, keeped on 30 minutes, sinus cavity formed with satisfactory results.2. The animal experiments: pressure measurement: pulmonary artery systolic pressure of preoperative were 22.00±3.61, pulmonary artery systolic pressure of postoperative were 23.00±3.39,0.2 <P <0.4; pulmonary artery systolic pressure / aortic systolic blood pressure of preoperative were 0.28±0.01, postoperative were 0.29±0.01,0.1 <P <0.2; right ventricular - pulmonary arterial pressure difference of preoperative were 4.00±2.24, postoperative were 4.20±2.59, P> 0.5; There are not yet considered the difference between preoperative and postoperative3. Echocardiography examination of a week after operating: 1 case had no pulmonary regurgitation, 1 case had mild pulmonary regurgitation, no case had moderate and ponderosu pulmonary regurgitation, the valves opened and closed were well. At 1、3、6 months after the operation, the datas were all 1 cases, 0 case and 0 case, the valves were well,too.Conclusion1. Repeated experiments, the producing craft and the process flow of using PRECLUDE pericardium and Gore-Tex artificial vessel as valve and vessel material respectively is that the pressure should be maintained at 100kpa continuously with air compressor, at the same time, the Gore-Tex vascular should be heated to 180℃by High-temperature chamber, for 30 minutes. The result is satisfactory.2 . Using PRECLUDE pericardial material for the valve, and Gore-Tex vascular grafts material for the right heart chamber sinus valved conduit to right ventricular outflow tract reconstruction has good prospects for development.更多还原