CN210131233U - percutaneous left heart drain - Google Patents

Abstract

The utility model discloses a percutaneous left heart drainage tube, which comprises a ventricle section positioned in the left ventricle and an artery section (1) positioned in the external artery of the left ventricle, wherein the included angle between the ventricle section and the artery section (1) is 160-175 degrees; the ventricular segment consists of an inhalation segment (3) and a non-inhalation segment (2), the inhalation segment (3) is positioned at the tail end, and a plurality of inhalation side holes (4) are formed in the wall of the inhalation segment (3); the non-suction section (2) and the artery section (1) are externally sleeved with plastic spring rings (7); the utility model discloses percutaneous left heart drainage tube can be put into through axillary artery or carotid, and operation flow simplifies, can realize left heart drainage in coordination with ventricle auxiliary device. The drainage catheter is directly placed in the left ventricle under the guidance of cardiac ultrasound or DSA through the peripheral blood vessel, and high-risk invasive operation such as atrial septum puncture or ventricular opening is not needed; in addition, the percutaneous left heart drainage tube can effectively drain left ventricle blood, and reduces the load of ventricles through the catheter in the ventricular assist.

Description

percutaneous left heart drain

technical field

The utility model relates to a left heart drainage tube, in particular to a percutaneous left heart drainage tube, which belongs to the technical field of medical devices.

Background technique

Heart failure is a worldwide public health problem with high morbidity, poor prognosis and heavy economic burden. The global incidence rate of people aged 30-65 years is 1.5-2%, and the incidence rate of people over 65 years old is 6-10%, and the incidence rate is continuing to rise. Heart failure treatment includes drug therapy, cardiac resynchronization therapy, heart transplantation and mechanical assisted circulation. Although the drug treatment of heart failure continues to be optimized, studies have shown that the overall 5-year survival rate does not exceed 50%, and the survival rate of end-stage heart failure is even lower.

Ventricular assist devices can reduce cardiac work and provide circulatory support. Ventricular assist devices have been used clinically since the 1960s, not only for the treatment of acute heart failure during surgery, but also for the transition to heart transplantation. BTT) to improve the quality of life of patients, promote the recovery of cardiac function, and improve the survival rate. In some patients with reversible heart failure, ventricular assist devices may be used to restore the cardiac function of patients. Ventricular assist devices are divided into first-generation pulsatile ventricular assist devices according to the type of blood pump, which have been gradually phased out; second-generation axial flow and centrifugal pump continuous ventricular assist devices are currently the most widely used ventricular assist devices; third-generation magnetic levitation ventricular assist devices Auxiliary devices are technically difficult and expensive and have not yet been used in large-scale clinical applications.

Ventricular assist devices are classified into implant-assisted and percutaneous-assisted devices according to whether they are implanted into the body. Implantable left ventricular assist devices require surgery to establish left ventricle-to-aortic access under cardiopulmonary bypass, and not all patients can tolerate surgery. In addition, studies have shown that patients with severe cardiogenic shock have a higher postoperative mortality rate if a long-term left ventricular assist device is implanted. Percutaneous ventricular devices can be rapidly placed to achieve LV unloading, reduce LV filling pressure and LV volume, and increase cardiac output to restore perfusion to vital organs.

The intubation method and intubation type of percutaneous ventricular assist device largely determine the clinical effect of ventricular assist, intubation speed, incidence of complications, and applicable environment. Traditional percutaneous ventricular assist devices such as extracorporeal membrane oxygenation (ECMO): a continuous flow centrifugal blood pump is used to draw venous blood through a venous catheter (15-29Fr) inserted in the femoral vein. Oxygenated blood was injected into the abdominal aorta after membrane oxygenation via a ductus arteriosus (15-23Fr) in the femoral artery. Disadvantages: This intubation method causes an increase in left ventricular afterload, which leads to blood accumulation in the left ventricle, which may lead to an increase in left ventricular end-diastolic pressure (LVEDP), pulmonary capillary wedge pressure (PCWP) and Decreased stroke volume further exacerbates the hyperemic state of the left ventricle, and there is a risk of bleeding at the cannulation site and distal limb ischemia.

Intra-aortic balloon pump (IABP) consists of a 7.0-8.0Fr double-lumen catheter and a cylindrical polyethylene balloon. The balloon is passed through the femoral artery or axillary artery through a delivery sheath. Placed in the aorta, disadvantages: can not significantly increase cardiac output, there are potential risks such as limb ischemia, vascular trauma, thrombosis, hemolysis, thrombocytopenia, etc.

Impella is a percutaneously implanted axial flow ventricular assist device that pumps left ventricular blood into the aorta by passing a micro-axial flow pump attached to the end of a pigtail catheter through the aortic valve through femoral artery puncture. Disadvantages: Small axial flow pumps require high rotational speed (33,000-51,000 rpm) to maintain flow, increasing the risk of blood damage. In addition, this intubation method has complications such as inguinal hematoma and catheter breakage.

The TandemHeart is an extracorporeal continuous flow centrifugal pump with a drainage tube through the femoral vein or internal jugular vein to the right atrium, and a 21F catheter is placed into the left atrium through atrial septal puncture. A 15-Fr to 17Fr perfusion catheter is usually placed in the femoral artery. Disadvantages: The entire implantation procedure must be performed in the catheterization laboratory; the size of the cannula is large, and limb ischemia distal to the femoral artery is a serious complication; atrial septal puncture increases iatrogenic injury.

The existing percutaneous ventricular assist device cannula is basically placed through the femoral artery and vein, and some of the device catheter ends are positioned in the large blood vessels or the left atrium, which cannot adequately drain the left ventricle and reduce the load on the left ventricle. For example, the auxiliary device disclosed in the patent document with the publication number of CN104174078A, the left heart auxiliary device inserted through the femoral artery belongs to the first generation of pulsatile ventricular assist device, in which a one-way valve is required to control the direction of blood flow, and the risk of thrombosis and blood damage is high. In addition, the femoral artery is thick, but the pressure is high, and the incidence of bleeding around the catheter is high. Once the catheter slips, a fatal accident will occur. The puncture point of the femoral artery is far away from the aorta and left ventricle, and the catheter spans the entire aorta. A longer catheter will increase the risk of thrombosis. In addition, there are many branches from the femoral artery to the left ventricle, which makes it difficult to place the catheter, and the front end of the catheter is damaged. Risk of other collateral vessels.

In summary, how to design an appropriate cannula to achieve rapid, effective and safe establishment of auxiliary circulation, simplify the operation process, cooperate with ventricular assist devices, achieve left ventricular drainage, and reduce ventricular load has become an urgent problem for those skilled in the art.

Utility model content

In view of the deficiencies of the prior art, in order to solve at least one of the above technical problems, the present invention provides a percutaneous left ventricular drainage tube, which can realize the establishment of a rapid, effective and safe auxiliary circulation, simplify the operation process, and cooperate with the ventricular assist device to realize the Drain the heart to reduce ventricular load.

The technical scheme that the utility model solves the above-mentioned technical problem is:

A percutaneous left ventricular drainage tube, comprising a ventricular segment located in the left ventricle and an arterial segment located in an external left ventricular artery, the angle between the ventricular segment and the arterial segment is 160°-175°; the ventricular segment It is composed of an inhalation section and a non-inhalation section, the inhalation section is located at the end, and a plurality of inhalation side holes are arranged on the pipe wall of the inhalation section for inhaling the blood in the left ventricle; the non-inhalation section and the arterial section coat There is a plastic spring ring, which plays a supporting and fixing role.

In order to avoid the mitral valve in the left ventricle, the inhalation segment is 1.5 cm and the non-inhalation segment is 3.5 cm.

During isovolumic systole, when the mitral valve is closed but the aortic valve has not yet opened, the heart chamber is in a "closed" state, the pressure in the left ventricle increases sharply, and a large overall vortex appears in the entire left ventricular chamber (maybe Observed by VFM technology (VectorFlow Mapping), the shape is oval, the streamline is loose, and the flow is counterclockwise, and the blood flow turns to the left ventricular outflow tract at the apex; ejection period: at the moment when the aortic valve opens , the overall vortex in the left ventricular cavity disappears, and the blood flow in the left ventricular outflow tract under the aortic valve accelerates into the aorta in a laminar flow manner. A small local vortex is seen in the left ventricular inflow tract, which persists until the beginning of mid-ejection, and then disappears at the beginning of mid-ejection. After that, the left ventricular chamber shows a gradually accelerated laminar flow signal from the apex to the left ventricular outflow tract. At the end of ejection , a small eddy current appears under the aortic valve; isovolumic relaxation period: when the aortic valve closes immediately before entering the isovolumic relaxation period, the blood flow in the left ventricle rapidly turns into a low-velocity laminar flow toward the apex, and the velocity gradient is higher than other The cardiac phase should be low; the rapid filling phase: at this time, the blood flow of the left atrium quickly enters the left ventricle through the mitral valve in a laminar manner, and flows along the left ventricular inflow tract to the apex of the left ventricle; the slow filling phase: the rapid filling phase enters the left ventricle The blood flow in the room reaches the apex of the left ventricle and turns counterclockwise, away from the apex of the left ventricle, and flows in the direction of the left ventricular outflow tract. Systolic phase: When the left atrium contracts, the blood flow in the left atrium enters the left ventricle again in the form of laminar flow, and continues with the overall eddy current during the rapid filling period. The flow together forms an overall vortex distributed throughout the cardiac chamber. The streamline is counterclockwise and continues until the isovolumic systole of the next cardiac cycle.

As shown in Figure 1, a vortex is seen beneath the mitral valve leaflets in early systole in healthy adults. With the contraction of the left ventricular wall, the pressure in the left ventricular cavity increases, the blood flow of the left ventricular cavity flows out from the base of the left ventricle to the aorta, and a part of the blood flow flows backward along the mitral valve. An accelerating vortex is created in the LV cavity on the ventricular surface of the valve. In late systole, the axis of basal flow was roughly parallel to the ventricular septum, and the velocity vector was distributed along the left ventricular cavity near the 3/4 area of the ventricular septum, and its direction was from the apical segment of the left ventricle to the aorta along the direction of the basal flow.

Under normal circumstances, the flow field in the left ventricular outflow tract and the duct is laminar flow, and there is a vortex under the mitral valve leaflet. If the vortex enters the lumen, the vortex can cause disturbance in the entire lumen. At the same time, the ventricular assist device provides a large negative pressure for the drainage tube. The suction section is located at the vortex, which will interfere with the laminar flow in the pipeline. The existence of negative pressure in the pipeline makes the blood run in the pipeline in the form of turbulent flow. Turbulent flow in the pipe produces Reynolds stress, which is much higher than viscous stress and is one of the main reasons for the destruction of blood cells. Furthermore, turbulent flow creates unnecessary energy consumption, reducing overall ventricular assist efficiency. The turbulent flow at the drainage end continues to the perfusion end, which will produce shear stress on the vascular endothelium, damage the vascular endothelium, and cause necrosis and calcification of the vascular wall.

In order to solve the above problems and avoid the influence of eddy current on the drainage tube, the suction section needs to avoid the left ventricular inflow tract, including the area below the mitral valve. Therefore, the optimal area for the suction section is the area from the ventricular septum to the left ventricular outflow tract. Therefore, the included angle between the ventricular segment and the arterial segment is 160°-175°, so that the drainage tube avoids the vortex under the mitral valve and avoids the influence of the vortex on the pipeline flow and the pipeline position. At this angle, the drainage tube is distributed close to the left ventricular cavity and close to the 3/4 area of the interventricular septum, avoiding the left ventricular inflow channel with vortex flow, and the laminar flow environment is more conducive to left ventricular drainage.

In addition, the mitral valve and aortic valve can be seen in the left ventricular cavity. The mitral valve body is longer and is like a sheet film, which is easily sucked into the suction side hole of the suction segment, resulting in poor drainage and valve damage. The above angles and lengths are designed to avoid the mitral valve, not to damage the valve, and not to adhere to the wall.

The angle between the ventricular segment and the arterial segment also facilitates the angle between the brachiocephalic trunk and the aortic arch, and the angle between the ascending aorta and the left ventricular cavity. In the range of 160°-175° included angle, the suction segment can avoid the possibility of being adsorbed to the mitral valve leaflets, and it can also ensure that the suction segment is located in the left ventricular inflow tract.

The traditional drainage tube is a thick silicone tube, which is hard and has poor position controllability. It is more likely to damage the ventricular wall, valve, chordae tendineae, etc. due to improper operation. The suction section is connected with a pigtail catheter (pigtail catheter). The pigtail catheter is made of soft material, with low risk of ventricular tissue damage and easy positioning. After the pigtail catheter is placed in the ventricle, the distal end of the pigtail catheter is naturally coiled in a pigtail shape to avoid the catheter head and the ventricular tissue. direct contact.

For positioning, especially for visualization positioning, a metal positioning ring is provided at the junction of the ventricular segment and the arterial segment.

The end of the arterial segment is connected with a reducing tube, which is connected to an extracorporeal circulation pipeline, and the reducing tube, the extracorporeal circulation pipeline and the drainage tube constitute a circulating pipeline to realize blood circulation.

A positioning sheath (vascular sheath) is arranged outside the arterial segment, and when the pipeline is inserted, the positioning sheath is connected with the artificial blood vessel, and is sealed so that no blood leakage occurs.

Preferably, the total area of the plurality of suction side holes is greater than the cross-sectional area of the arterial or ventricular segment. Poiseuille's law describes the laws of liquid flow in a piping system. It can be known from Poiseuille's law that the diameter of the tube is an important factor in determining the blood flow when other factors are the same. The total area of the multiple suction side holes is larger than the cross-sectional area of the arterial segment or the ventricular segment, which ensures the maximum drainage volume of the pipeline and enhances the ventricular drainage effect.

The percutaneous left heart drainage tube can be placed through the axillary artery or carotid artery, wherein the axillary artery cannula is placed for minimally invasive surgery, and the carotid artery cannula is placed through percutaneous puncture. Both carotid artery and axillary artery cannulae can be placed quickly, and trained and experienced physicians can successfully place the cannula within 30 minutes. The operation process is simplified, and it can cooperate with ventricular assist devices to achieve left ventricular drainage. The drainage catheter is placed in the left ventricle directly through the peripheral blood vessels under the guidance of echocardiography or DSA, and high-risk invasive procedures such as atrial septal puncture or ventricular opening are not required. In addition, the percutaneous left ventricular drainage tube can effectively drain the blood of the left ventricle, and the ventricular load can be reduced through the catheter during ventricular assistance.

Description of drawings

Figure 1 is a schematic diagram of the left ventricle.

Figure 2 is a schematic diagram of the drainage tube (without plastic spring coils) of the present invention.

Figure 3 is a schematic diagram of the drainage tube of the present invention.

Detailed ways

The present utility model will be described in further detail below with reference to the accompanying drawings and specific embodiments.

As shown in Figures 2 and 3, the percutaneous left heart drainage tube is made of medical PVC or a new type of polyurethane tube. Including the ventricular segment located in the left ventricle and the arterial segment 1 located in the artery outside the left ventricle, the specifications of the ventricular segment and the arterial segment 1 are 21Fr. The angle α between the ventricular segment and the arterial segment 1 is 165° (160°～175° can be used), in order to fix the angle between the ventricular segment and the arterial segment 1, the ventricular segment and the arterial segment 1 are connected There is a metal positioning ring, which is not marked in the figure. The setting of the metal positioning ring can be developed (eg, irradiated by an X-ray machine) to position the pipeline.

The ventricular segment is composed of an inhalation segment 3 and a non-inhalation segment 2. The inhalation segment 3 is located at the end, the inhalation segment 3 is 1.5 cm, the non-inhalation segment 2 is 3.5 cm, and the tube wall of the inhalation segment 3 is 3.5 cm. A plurality of suction side holes 4 are arranged on the upper part, and the total area of the plurality of suction side holes 4 is larger than the cross-sectional area of the arterial segment 1 (or the ventricular segment). A pigtail conduit 5 is connected to the suction section 3 . The non-suction section 2 and the arterial section 1 are covered with plastic spring coils 7 to support and fix the pipeline.

The end of described arterial segment 1 is connected with reducing pipe 6, reducing pipe 6 is 3/8 inch, reducing pipe 6 is externally connected to extracorporeal circulation pipeline (being 3/8 inch), reducing pipe 6, extracorporeal circulation pipeline and The drainage tube constitutes a circulation pipeline to realize blood circulation. A positioning sheath is provided outside the arterial segment 1, which is not shown in Figures 2 and 3 . The positioning sheath (also called the vascular sheath) is connected to the artificial blood vessel when the tube is placed, and it is sealed so that no blood leakage occurs.

The percutaneous left heart drainage tube of the utility model is inserted through the axillary artery or the carotid artery, and the diameter-reducing tube 6 is externally connected. middle. The blood pump pumps the blood in the left ventricle, and flows into the artery through the drainage tube and the reducing tube 6 of the utility model, which effectively realizes the drainage of the left ventricular blood and reduces the load on the ventricle.

The above embodiments do not limit the present invention in any way, and all technical solutions obtained by means of equivalent replacement or equivalent transformation fall within the protection scope of the present invention.

Claims (7)

1. Percutaneous left ventricular drainage tube, characterized in that it comprises a ventricular segment located in the left ventricle and an arterial segment (1) located in an artery outside the left ventricle, and the angle between the ventricular segment and the arterial segment (1) is 160° to 175°; the ventricle segment is composed of an inhalation segment (3) and a non-inhalation segment (2), the inhalation segment (3) is located at the end, and the pipe wall of the inhalation segment (3) is provided with a plurality of The suction side hole (4); the non-suction section (2) and the arterial section (1) are covered with plastic spring coils (7). 2 . The percutaneous left heart drainage tube according to claim 1 , wherein the suction section ( 3 ) is 1.5 cm, and the non-suction section ( 2 ) is 3.5 cm. 3 . 3 . The percutaneous left heart drainage tube according to claim 1 , wherein the suction section ( 3 ) is connected with a pig tail catheter ( 5 ). 4 . 4 . The percutaneous left heart drainage tube according to claim 1 , wherein a metal positioning ring is provided at the connection between the ventricular segment and the arterial segment ( 1 ). 5 . 5 . The percutaneous left heart drainage tube according to claim 1 , wherein: the end of the arterial segment ( 1 ) is connected with a reducing tube ( 6 ). 6 . 6 . The percutaneous left heart drainage tube according to claim 5 , wherein a positioning sheath is provided outside the arterial segment ( 1 ). 7 . 7 . The percutaneous left heart drainage tube according to claim 1 , wherein the total area of the plurality of suction side holes ( 4 ) is larger than the cross-sectional area of the arterial segment ( 1 ) or the ventricular segment. 8 .

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