二尖瓣瓣环成形技术__培训课件.ppt

* 安置前瓣环缝线 先在两个三角之间的前瓣环间断安置缝线，每针跨度约2mm,缝线上行穿挂人工瓣环的针距宜为2mm,有益前瓣环正常曲度的维持。 安置交界和后瓣环缝线 在交界处和后瓣环安置缝线，跨度为约4mm。将这些缝线分别穿过人工瓣环，并且在人工瓣环上的跨度为2mm，这样可以起到缩小扩大的后瓣环的作用。通常总共缝合约11-13针，缝合时注意不要缝到回旋支。 * 用手柄将人工瓣环向下推到二尖瓣环上，同时向上提缝线,去除手柄后保留瓣环支撑架打结缝线，最后去除瓣环支撑架，完成人工瓣环植入。 * 人工瓣膜全环和瓣环塑性带 Paul Dagum 等于2001年比较了部分软环组、全软环组和正常对照组之间的结果。发现部分软环和全软环均对二尖瓣环有相同固定作用，即心动周期内二尖瓣环面积、横径和前后径均无明显变化。但是，部分软环保留了与正常对照组一样的二尖瓣环生理性弯曲折叠功能，而这一点对于瓣膜修复术的远期疗效和防止左室流出道梗阻可能非常重要。 * Carpentier-McCarthy-Adams IMR ETlogix 瓣膜成形环 Duran 人工成形环 国产佰仁思瓣膜成形环 Carpentier-Edwards 经典二尖瓣环 SJM Tailor? Ring * A. Medtronic Duran瓣环塑形带 B. Cosgrove-Edwards瓣环塑形带 C. SJM Tailor?瓣环塑形带 D. CarboMedics AnnuloFlex?瓣环塑形带 * Carpentier-Edwards Classic Annuloplasty Ring Solid titanium core provides strength and durability * * Carpentier-Edwards Physio Annuloplasty Ring Remodeling preserves natural 3:4 ratio between the anteroposterior diameter and transverse diameter during systole. * Carpentier-Edwards Physio II Annuloplasty Ring Invented by Alain F. Carpentier, MD, PhD and David H. Adams, MD Double saddle configuration True sewing cuff design more circular shape * Cosgrove-Edwards Annuloplasty System use in the mitral or tricuspid position. Flexible band adapts to three-dimensional contour * GeoForm Ring Remodel the mitral annulus Reform the left ventricle * Carpentier-McCarthy-Adams IMR ETlogix Annuloplasty Ring first asymmetric ring designed to treat asymmetric dilatation. Corrects for Type IIIb mitral regurgitation. Decreased anteroposterior (AP) distance increases leaflet coaptation. Increased sewing margin in the P2-P3 region, marked with suture, designed to accommodate a double-suture row. * Medtronic Fully rigid Profile 3D Ring Medtronic Semi-rigid CG Future Ring and Band System * Medtronic Flexible Duran AnCore Ring and Band System This flexibility allows your repaired mitral or tricuspid valve to continuously move a