少见地瓣膜治疗三尖瓣成形.ppt

植入 四维成像 Implantation Four Dimensional Imaging * * * * * * Retrograde flow Forward flow Retrograde flow Forward flow Conclusions Design issues Separation of sealing, fixation, and annular function Critical for the venous system and right heart Valvular competence in the setting of variable venous diameter High compliance system Unsure of physiologic benefit but clear absence of retrograde flow throughout follow-up * * * * * * * * * * * * * * * * * * * * * * * * * * * * 少见的瓣膜治疗: 三尖瓣成形 Roy K Greenberg, MD 特别声明 研究得到的支持 Cook Inc, Boston Scientific, W.L.Gore, Cordis, Vascutek, Terarecon Consulting, Intellectual Property, Travel Expenses Cook Inc 病例报道 65yo 女性，顽固腹水 既往史：左侧乳腺切除，放疗，LUE 淋巴水肿 4+ 三尖瓣关闭不全, 缩窄性心包炎 (s/p 胸腔镜检，心包部分切除术) 术前超声心动图 瓣膜构造的问题 静脉系统的直径不是固定的 肝静脉和下腔静脉瓣之间距离很短 左颈内静脉/锁骨下静脉血栓 开放压力相对低 术中固定到支架移植物 制造反流 标记物 压缩及安装 Retrograde flow Forward flow Retrograde flow Forward flow 结论 设计方面的问题 封闭，固定和瓣环功能的分别处理 对于静脉系统和右心非常关键 在不同的静脉直径条件下瓣膜的闭合情况 高顺应性系统 生理学的优势还不确定，但是在随访中明确没有发现有逆向血流 Less Common Valvular Interventions: Tricuspid Valve Repair Roy K Greenberg, MD Disclosure Research support Cook Inc, Boston Scientific, W.L.Gore, Cordis, Vascutek, Terarecon Consulting, Intellectual Property, Travel Expenses Cook Inc Patient Presentation 65yo female with intractable ascites Prior left mastectomy, radiation therapy, LUE lymphedema 4+ tricuspid regurgitation, constrictive pericarditis (s/p thoracoscopy with subtotal pericardectomy) Preoperative Echocardiography Valve Construct Issues Non-fixed diameter of the venous system Short distance between hepatic veins and eustacian valve Thrombosis of the left internal jugular/subclavian veins Comparitively low opening pressures Intraoperative Mounting To Scaffold Stentgraft Creation of Insufficiency Markers Packaging and Loading