CN109770972B

CN109770972B - Aortic root suture positioning mold

Info

Publication number: CN109770972B
Application number: CN201910231871.7A
Authority: CN
Inventors: 贾兵; 张惠锋; 杨西斌
Original assignee: Childrens Hospital of Fudan University
Current assignee: Childrens Hospital of Fudan University
Priority date: 2019-03-26
Filing date: 2019-03-26
Publication date: 2024-11-22
Anticipated expiration: 2039-03-26
Also published as: CN109770972A

Abstract

The present invention discloses an aortic root suture positioning mold, which relates to the field of medical technology and is applied to aortic valve pericardioplasty. The mold comprises a mold body, a long handle, a circular ring structure and an arc structure. The bottom of the mold body is a circular ring structure, and above the circular ring structure are three connected arc structures, and a long handle is arranged adjacent to the connected arc structures. The present invention standardizes the sewing process, greatly reduces the operation time, ensures the shaping effect, and provides a new and effective surgical method for the treatment of aortic valve lesions in children.

Description

Aortic root sewing positioning die

Technical Field

The invention relates to the technical field of medical treatment, in particular to an aortic root sewing and positioning die.

Background

In recent years, more and more aortic valve lesions of children need clinical correction, and become a focus of attention for treating heart diseases of children. However, unlike adults, infantile aortic valve lesions are mainly congenital dysplasia, often involve multiple valve leaflets, and have complicated and serious lesions and large individual differences. Therefore, the surgical shaping repair has high difficulty and high re-intervention rate, becomes one of the difficulties in the field of treatment of the pediatric heart disease, and brings great challenges to the pediatric heart surgeon.

Current surgical approaches to aortic valve pathology include aortic valve shaping and valve replacement. The aortic valve replacement operation is simple, the function of the artificial valve after operation is good, and the artificial valve is the most common operation mode for adult aortic valve lesions. However, the artificial valve cannot grow, the mechanical valve needs lifelong anticoagulation, and the biological valve has high calcification decay rate, so that the artificial valve obviously cannot become the first operation mode of children patients. The aortic valve with autologous pulmonary valve replacement lesions (i.e., ROSS surgery) is considered as the recommended procedure for pediatric aortic valve lesion treatment, avoiding long-term anticoagulation and calcification. However, the artificial valved outer tube is required to reconstruct the right ventricular outflow tract in the operation, and the problem that the outer tube is decayed and needs to be replaced by a plurality of operations still exists. At the same time, the occurrence of new aortic valve root dilatation and regurgitation exists in the middle and long term, and complicated operations such as aortic root replacement, valve re-intervention and the like are required. It follows that the ROSS procedure is likely to transform a "single valve lesion" into a "double valve lesion".

Thus, aortic valve forming surgery is the surgical method of choice for pediatric aortic valve lesions. The most common shaping means include interfacial cutting, leaflet extension, folding, suspension, perforation repair, and the like. The shaping modes are mainly based on repairing the valve with the original lesion, the shaping effect often depends on the degree of the valve leaflet lesion, and the shaping method has a better effect on the treatment of the aortic valve single-leaflet lesion and the simple lesion. Even so, its 5 year re-operation rate is still as high as ten percent. Kalangos and Myers reported in 2013 that 77 cases of aortic valve repair due to rheumatic aortic valve disease using leaflet extension technique, 1 case of early and late death, and 5, 10, and 15 cases of early and late death were free from surgery at 88.5%, 81.7%, and 79.7%, respectively. However, for those with complex lesions or multiple leaflets involved, the corrective effect of the above described repair techniques is not ideal, and more than one third of patients need to undergo a re-operation within 10 years due to valve decay. The following visits of 34 children with less than 3 months of age, who received valvulotomy due to serious stenosis of aortic valve, were made by Miyamoto et al in 2016, and the re-intervention-free rates for 5, 10 and 15 years were 85.1%, 78.0% and 53.5%, respectively. Western scholars believe that the younger of the procedure, the bileaflet aortic valve, may be a risk factor for valve decay after the procedure.

The aortic valve forming of the self-body pericardium is a novel aortic valve repairing technology, which is proposed by Duran and the like for the first time, and the self-body pericardium is used for completely replacing the diseased aortic valve so as to complete the reconstruction of the new aortic valve, thereby being applicable to the complicated aortic valve lesion which is difficult to repair. The autologous pericardial aortic valve forming technology has good effect in the treatment of adult aortic valve lesions through continuous technical improvement. Ozaki et al applied this technique to treat 788 cases of adult aortic valve lesions, including 534 cases of stenosis and 254 cases of insufficiency, and severe leaflet malformations including 224 cases of two-leaflet aortic valve, 28 cases of single-leaflet aortic valve, and 2 cases of four-leaflet aortic valve. The average follow-up period was 53.7 months, the average transvalve pressure difference was 15.2mmHg 8 years after surgery, and only 4.2% of patients needed to undergo further surgery. Due to the low mortality rate and low re-operation rate after operation, the operation is gradually accepted by cardiac surgeons of various countries. Reuthebuch et al report a follow-up of this procedure at 30 cases (7 cases of stenosis, 12 regurgitation and 11 cases of stenosis combined regurgitation) at the university of barsel hospital in switzerland from 2015, with a mortality rate of 3.33% (n=1) within 30 days after surgery, with no re-operator within 3 months after surgery. Some cardiac surgeons in germany, spanish, etc. use this technique clinically for aortic valve repair with good early follow-up results.

However, the autologous pericardial aortic valve shaping technique has few examples of application in children cases and is inexperienced. The improvement and innovation of the Ozaki operation in the hospital is carried out, and the technology is firstly used for carrying out the tri-valve repair on the children aortic valve serious lesions or the patients with the multiple valve leaflets in clinic, so that the early postoperative follow-up shows good operation results. But the operation is complicated and requires a lot of time to measure the height and width of the cut valve. Due to the aortic valve development deformity of children, single-leaf type, two-leaf type or four-leaf type deformity often exists, even in the three-leaf type aortic valve, three valve leaf boundaries are unequal, sewing sites need to be repositioned, sewing heights are determined, repeated correction is often needed, and operation time is prolonged.

In summary, the invention designs an aortic root sewing and positioning die.

Disclosure of Invention

Aiming at the defects existing in the prior art, the invention aims to provide the aortic root sewing and positioning die, standardizes the sewing process, greatly reduces the operation time, ensures the forming effect and provides a novel and effective operation mode for the treatment of aortic valve lesions of children.

In order to achieve the above object, the present invention is realized by the following technical scheme: the aortic root sewing positioning die comprises a die main body, a long handle, a circular ring structure and an arc-shaped structure, wherein the bottom of the die main body is of the circular ring structure, three connected arc-shaped structures are arranged above the circular ring structure, and the long handle is arranged at the adjacent positions of the connected arc-shaped structures.

Preferably, the opening directions of the arc structures are consistent.

Preferably, the die body can be designed into different sizes according to the diameter of the aortic valve.

The invention has the beneficial effects that: the invention standardizes the sewing process, greatly reduces the operation time, ensures the forming effect and provides a novel and effective operation mode for the treatment of aortic valve lesions of children. The standardized aortic valve forming technology ensures the effect of aortic valve operation, simplifies the original complex operation, is standardized and simplified, is easy to popularize and apply, and tends to reduce the aortic valve replacement rate and the incidence rate of related complications of children. The method can be popularized to adults in future, greatly reduces the replacement proportion of aortic valves of the whole population, improves the life quality and prognosis, and has extremely high social value and economic value.

Drawings

The invention is described in detail below with reference to the drawings and the detailed description;

fig. 1 is a schematic structural view of the present invention.

Detailed Description

The invention is further described in connection with the following detailed description, in order to make the technical means, the creation characteristics, the achievement of the purpose and the effect of the invention easy to understand.

Referring to fig. 1, the present embodiment adopts the following technical scheme: the aortic root sewing positioning die comprises a die main body 1, a long handle 2, a circular ring structure 3 and an arc-shaped structure 4, wherein the circular ring structure 3 is arranged at the bottom of the die main body 1, three connected arc-shaped structures 4 are arranged above the circular ring structure 3, and the long handle 2 is arranged at the adjacent positions of the connected arc-shaped structures 4.

It should be noted that the opening directions of the arc-shaped structures 4 are consistent, and the same type of arc-shaped structures have the same size.

In addition, the die body 1 can be designed into different sizes according to the diameter of the aortic valve.

The positioning die of the specific embodiment is designed to be circular at the bottom, three arcs are connected with one another at the body, the positioning die is of a three-dimensional structure with a long handle, different sizes and models are designed, and two functions are achieved: firstly, the diameter of the aortic valve annulus is measured (measured through a circular ring structure), secondly, the suture position of the new aortic valve is positioned (positioned through an arc), and thirdly, the junction height of three valve leaflets of the new aortic valve is positioned (two are positioned through the most peak of the arc, and one is positioned through a marking line A of a long handle). The small dots and small short standoffs in fig. 1 are pointing indicia when the needle is sewn; the small short vertical is the lowest point of the arc, the small points are slightly dense at the bottom and gradually sparse upwards, and the figure is marked with a 15-size model.

The aortic valve pericardium forming concrete implementation process comprises the following steps: firstly cutting off diseased aortic valve leaflets of the patient, cutting the pericardium processed by glutaraldehyde into three arc-shaped connected valve leaflet structures according to a cutting die, measuring the diameters of aortic valves by using aortic root positioning sewing dies with different sizes, selecting aortic root positioning sewing dies with proper sizes, placing left and right coronary artery openings in the center of the arc shape when positioning, avoiding influencing the openings when sewing, then tracing the arc shape, a valve She Feng point and a junction forming point, sewing the cut pericardium on the aortic root according to the traced point and line after finishing, starting sewing from the lowest point, then going to the two sides until the highest point of the arc shape, and finally carrying out junction forming of new aortic valve leaflets. The small dots and small short standoffs in fig. 1 are indicia of a needle; the small short vertical lines are arc lowest points, the small points are slightly dense at the bottom and gradually sparse upwards, and 15 in the figure is a size mark.

The specific embodiment standardizes the sewing process, greatly reduces the operation time, ensures the forming effect and provides a novel and effective operation mode for the treatment of the aortic valve lesions of children.

The foregoing has shown and described the basic principles and main features of the present invention and the advantages of the present invention. It will be understood by those skilled in the art that the present invention is not limited to the embodiments described above, and that the above embodiments and descriptions are merely illustrative of the principles of the present invention, and various changes and modifications may be made without departing from the spirit and scope of the invention, which is defined in the appended claims. The scope of the invention is defined by the appended claims and equivalents thereof.

Claims

1. The aortic root sewing and positioning die is characterized by comprising a die main body (1), a long handle (2), a circular ring structure (3) and an arc-shaped structure (4), wherein the circular ring structure (3) is arranged at the bottom of the die main body (1), three connected arc-shaped structures (4) are arranged above the circular ring structure (3), and a long handle (2) is arranged at the adjacent part of the connected arc-shaped structures (4); the arc-shaped structure (4) is internally provided with small points marked by stitching and small short vertical columns, wherein the small short vertical columns are arc-shaped lowest points, the small points are dense at the bottom and gradually sparse upwards;

The marking line A of the long handle (2) and the most points of the two arc-shaped structures (4) are used for positioning the height of the boundary of three valve leaflets of the new aorta.

2. The aortic root sewing positioning die according to claim 1, wherein the opening direction of the arc-shaped structure (4) is consistent.

3. The aortic root sewing positioning die according to claim 1, wherein the die main body (1) is designed into different sizes according to the diameter of the aortic valve.