开胸经导管植入带瓣膜支架置换肺动脉瓣的实验观察

Transcatheter pulmonary valve replacement in sheeps： 6-month evaluation of self-expandlng valved stents

目的探讨开胸经导管植入带瓣膜支架置换肺动脉瓣的可行性以及6个月的实验效果。方法以新鲜的羊心包为材料，给予0．6％戊二醛浸泡36h后缝合在瓣膜环上，并将其固定在镍钛记忆合金自膨胀支架上，制成带瓣膜肺动脉支架。选择体重为（23．5±3．1）kg的健康羊，通过开胸、穿刺右心室前壁，将带瓣膜支架经导管植入至肺动脉瓣处，置换自身肺动脉瓣膜，随访6个月，观察实验效果。结果1只羊术后4个月死于肺动脉支架内血栓形成，4只羊随访6个月，心脏彩色超声、右心室以及肺动脉瓣上造影证实支架的位置及瓣膜功能良好，64排CT检查发现支架无移位。结论开胸经导管植入带瓣膜支架置换肺动脉瓣方法可行，随访6个月效果理想。

Objective The purpose of this study was to determine the feasibility of transcatheter pulmonary valve replacement in sheeps up to 6 months post procedure. Methods Fresh sheep pericardium treated with a 0. 6% glutaraldehyde solution for 36 hours was sutured to a valvular ring and then fixed onto a newly designed nitinol self-expandable stenL Thoracotomy was performed in sheeps （23.5 ± 3.1 ） kg under general anesthesia and the device was delivered into the native pulmonary valve of the sheeps via the anterior wall of right ventricle by catheter and fooled for 6 months. Results One sheep died 4 months after the procedure due to in-stent thrombosis. Another 4 animals survived the 6-month observing period. Angiographic and hemodynamic measurements confirmed good positioning and function of the stents with a competent valve immediately post procedure and 6 months post the procedure in surviving animals. Conclusion Implantation of the nitinol self-expandable stent in the pulmonary valve position by a transcatheter approach is feasible and good function of transeatheter implanted memory nitinol valved stents was shown after 6 months of implantation in sheeps.