无支架房室瓣膜替换三尖瓣的实验研究

Experimental study on tricuspid valve replacement with a stentless atrioventricular valve

探索无支架房室瓣膜替换三尖瓣外科技术。方法选用深低温保存犬二尖瓣制成的无支架房室瓣膜１０枚，体外循环下将其前叶缝合于犬三尖瓣隔瓣环，后叶缝合于三尖瓣前后瓣环，两乳头肌缝合于右室前壁。血流动力学监测，测定计算移植瓣膜跨瓣压差、瓣口面积，超声心动图测定其功能。结果１０条犬均顺利脱落ＣＰＢ。无房室传导阻滞。术后血流动力学稳定，术后无支架瓣膜平均跨瓣压差１５２ｍｍＨｇ±０．４２ｍｍＨｇ（１ｍｍＨｇ＝０．１３３ｋＰａ）。１０条犬中，仅２条犬因手术失误造成少～中量返流。结论同种二尖瓣制成的无支架房室瓣膜设计合理，植入技术可行，在三尖瓣位置上近期血流动力学性能优良。

Objective To establish the surgical technique of tricuspid valve replacement with a stentlessatrioventricular valve and determine its function. Method Ten dogs received tricuspid valve replacement withstentless atrioventricular valves (cryopreserved mitral homografts). They were implanted in such a mannerthat the mitral homograft was orientated so as to position the mitral anterior leanet at the level of the septumand the mitral posterior leaflet at the site of tricuspid anterior and posterior leaflets. Two papillary muscleswere anchored onto the anterior right ventricular wall. Hemodynamic studies were carried out to determine andcalculate transvalvular gradient and tricuspid orifice area. The stentless atrioventricular valve function was investigated by echocardiography. Result Ten dogs were weaned from CPB with sinus rhythm and stablehemodynamics. No atrioventricular block occurred. Postoperative mean tansvalvular gradient was 1.52±0. 42mmHg. All dogs investigated by echocardiography had competent tricuspid valves, except two with mild tomoderate regurgitation due to surgical failure. Conclusion The stentless atrioventricular valve design for tricuspid implantation is reasonable and that the valve implanting technique is feasible. It functions properly intricuspid position.