JP6120305B2 - Training apparatus for treatment of congenital heart disease and training method using the same - Google Patents

Description

  The present invention relates to a training apparatus for congenital heart disease treatment that is suitable for catheter therapy training for congenital heart diseases such as atrial septal defect and ventricular septal defect, and training using the training apparatus It is about the method.

  The most common atrial septal defect is an atrial septal defect in which a hole called a defect hole is opened in the atrial septum that partitions the left and right atria. In a healthy person, the blood flow from the heart to the lungs and the blood flow from the heart through the artery to the whole body are equal, but if there is a defect hole in the atrial septum, the left atrium of the systemic circulatory system As blood flows into the right atrium, the pulmonary blood flow in the right heart system increases and the burden on the right heart system increases.If the defect hole is large, it causes serious symptoms such as heart failure. Treatment to close the defect hole is required.

  As a catheter treatment for such a congenital heart disease, closure using a device that functions as a closure plug has been performed.

  In the above device, two disks and a cylinder connecting them are integrally formed by weaving metal thin wires in a mesh shape, and a cloth is sewn on the inner surface so that liquid does not pass through.

  This device is rich in elasticity, and is folded into a long and narrow bar shape when moving in the delivery sheath (catheter), and is restored to the original disk when it comes out of the delivery sheath.

  Implementation of catheter therapy for congenital heart disease requires the acquisition of new catheter technology, and the realization of a training apparatus capable of performing catheter therapy training close to clinical practice is desired.

  Various devices for training the above catheter treatment have been proposed, and a training simulator using computer graphics is actually used.

  Further, the applicant of the present invention has proposed a cardiovascular system simulation model that can reproduce the cardiovascular system three-dimensionally and faithfully, and can be applied to the evaluation of a catheter device from a catheter procedure corresponding to a different blood vessel structure for each patient. (For example, refer to Patent Document 1).

JP 2008-237304 A

  However, since the former training simulator cannot use devices that are actually used in clinical practice, there is a problem that it is impossible to check the texture and behavior of devices in actual clinical practice, and to evaluate and develop devices. There is also a problem that the feeling of operation cannot be confirmed.

  The latter cardiovascular system simulation model can confirm the feeling of inserting a catheter into a blood vessel, but it also reproduces an atrial septal defect, which is a congenital heart disease. Therefore, it was not possible to train closure using a device that functions as a closure plug.

  The present invention has been made in consideration of the above-mentioned problems in training simulators and cardiovascular simulation models using computer graphics, and catheter treatment for congenital heart disease using a device actually used in clinical practice. It is intended to provide a training apparatus for treating congenital heart disease and a training method using the same.

A training device for the treatment of congenital heart disease according to the present invention,
A congenital heart disease model in which two compartments are adjacent to each other via a septum, and the congenital heart disease is three-dimensionally reproduced by providing a hole in the septum;
Pulsating flow supply means for causing fluid to flow through the two compartments and causing the fluid flow to pulsate;
The gist is that

  In the training device of the present invention, a part of the partition wall can be constituted by a removable part, and the hole can be provided in the replacement part.

  When the congenital heart disease model is a heart model simulating an atrial septal defect, an esophageal part simulating the esophagus can be provided adjacent to the heart model.

  Further, a vein part simulating a venous system is connected to the heart model, and the pulsatile flow generated by the pulsatile flow supply means is introduced into the heart model through the vein part and discharged from the heart model. The pulsating flow can be returned to the pulsating flow supply means.

  Moreover, the water tank which can accommodate the said heart model can be provided, and it can comprise so that the said heart model may be immersed in this water tank.

  The congenital heart disease model can be composed of a synthetic resin material having flexibility.

The training method for congenital heart disease treatment of the present invention comprises:
Prepare a heart disease model that three-dimensionally reproduces the heart disease by providing two compartments adjacent to each other via a partition wall and providing a hole in the partition wall,
In the two compartments, the fluid that causes pulsation by the pulsating flow supply means is flowed,
Producing a flow of fluid that moves in a short-circuit manner between the two compartments through the hole;
The gist is to perform training for closing the hole using a capping device.

  The success or failure of the training is confirmed by finding out by any means whether there is a fluid leak from the hole.

  The fluid used in the training device may be artificial blood or animal blood. However, the workability of the training environment after use of the training device, contamination problems in the training environment due to inevitable liquid leakage during training, etc. are considered. Then, it is desirable to use clean water.

  According to the training apparatus for congenital heart disease treatment and the training method using the same according to the present invention, since the congenital heart disease is faithfully modeled, a device actually used in clinical practice is used. It has the advantage of being able to perform catheter treatment training for the congenital heart disease.

It is a perspective view of the heart model in the training apparatus of the present invention. It is the perspective view which looked at the training apparatus of FIG. 1 from the left side surface side. It is an enlarged plan view of the atrial septal defect part in the training apparatus of FIG. (a)-(c) is a top view of each atrial septal defect | deletion part. (a) is the block diagram which looked at the whole structure of the training apparatus from the plane side, (b) is the block diagram seen from the lower surface side. (a)-(e) is explanatory drawing which shows the training method of the catheter treatment using the training apparatus of this invention.

Hereinafter, the present invention will be described in detail based on the embodiments shown in the drawings.
1. Configuration of Training Device In FIG. 1, a training device for congenital heart disease treatment has a heart model (congenital heart disease model) 1 that reproduces the congenital heart disease. It is provided in a water tank 2 made of transparent acrylic resin having dimensions of 35.6 cm in length, 44.6 cm in width, and 25.6 cm in height. A left atrial section (partition section) 4 (see FIG. 2) is provided below the right atrial section 3 and partially simulates the left atrium.

  Since the heart model 1 is composed of a plurality of parts, the water tank 2 is filled with water and the heart model 1 is immersed in the water for the purpose of completely preventing water leakage from each joint and mixing of air. It is composed.

  Between the right atrial part 3 and the left atrial part 4, a later-described atrial septum (partition) is formed, and a later-described atrial septal defect part (replacement part) is inserted into this atrial septum The part insertion part 5 for doing is provided.

  The heart model 1 is connected to an arterial route (arterial portion) and a venous route (venous portion) corresponding to the cardiovascular system.

  Specifically, the femoral vein part 6, the abdominal vena cava part 7, the thoracic vena cava part 8, the upper right pulmonary vein part 9, the right lower pulmonary vein part 10, the left upper pulmonary vein part 11, the left lower pulmonary vein part 12 ( 2), the superior vena cava portion 13 is connected, and the pulmonary artery portion 14 is connected as an arterial route. The vein part and the arterial part are each transparent and three-dimensionally formed.

  In the figure, reference numerals 15 and 16 denote pipes. The pipe 15 is provided to support an arterial part imitating a part of the ascending aorta. Further, the left ventricle is originally next to the left atrium 4 and is connected to the aorta, but the pipe 16 is omitted.

  The right atrial part 3, the left atrial part 4, each venous part, and each arterial part have flexibility so that the same sensation as when a delivery sheath (catheter) is passed through an actual organ or blood vessel can be obtained. It is made of a synthetic resin, specifically, a silicon resin-based material.

  A tubular esophagus part 17 simulating the esophagus is provided below the left atrial part 4 and substantially parallel to the thoracic vena cava part 8. One end 17a of the esophagus portion 17 protrudes from the side wall of the water tank 2, and a transesophageal echocardiogram can be inserted from the opening of the one end 17a. The other end 17b of the esophagus part 17 is closed.

  The esophagus part 17 and the heart model 1 are supported by the acrylic plate 18 and the like slightly lifted from the pedestal 19a of the base 19, and the heart model 1 and its surrounding vascular pathways are observed from a plane and a side. It can be done.

  FIG. 2 is a perspective view of the heart model 1 as viewed from the left side (direction of arrow A in FIG. 1).

  In the figure, an atrial septum 20 is located between the right atrial portion 3 located on the upper side and the left atrial portion 4 located on the lower side thereof, and toward the atrial septal portion 20, The atrial septal defect part is inserted from the side part insertion part 5.

  FIG. 3 is an enlarged plan view showing the part insertion portion 5.

  The figure shows a state in which the atrial septal defect part 21 is inserted partway through the slit of the part insertion part 5.

2. Atrial septal defect part The atrial septal defect part 21 is made of a thin plate material having a section slightly smaller than the opening section of the slit, and a defect hole part simulating the defect hole of the atrial septum at the insertion side end. 21a is provided.

  When the atrial septal defect part 21 is inserted from the part insertion part 5 in the direction of arrow B and completely inserted, the defect hole part 21a can be positioned substantially at the center of the atrial septal part 20. ing.

  The atrial septal defect part 21 was formed in a silicon resin sheet having an opening simulating a defect hole part in the central part, an acrylic resin thin plate for fixing the silicon resin sheet, and the acrylic resin thin plate. It is comprised from the holding part 21b.

  4 (a) to 4 (c) show examples of atrial septal defect parts.

  The most common defect in atrial septal defect is the central defect at the center of the atrial septum, but it is located off the center, and the shape of the hole is not circular. Some are elliptical.

  Therefore, a plurality of atrial septal defect parts simulating various defect holes are prepared.

  The atrial septal defect part 22 shown in FIG. 4A is formed so that the defective hole 22a is located in the center of the atrial septal part 20 (see FIG. 2). The atrial septal defect part 23 shown has a defect hole part 23a formed so as to be off the center of the atrial septal part 20, and the atrial septal defect part 24 shown in FIG. Are formed with an elliptical defect hole 24a.

  In addition to these atrial septal defect parts 22 to 24, various types of atrial septal defect parts such as a semicircular defect hole part and a long defect hole part can be prepared according to actual defect hole examples. .

3. Overall Configuration of Training Device FIG. 5 is a block diagram showing the overall configuration of the training device according to the present invention. In FIG. 5 (a), the training device is shown from the plane side, and FIG. Show. In addition, the arrow in a figure represents the direction where a pulsatile flow flows.

  In both figures, the training apparatus is provided with a pump 30 and a pulsating flow forming device 31 that pulsates the water fed from the discharge port 30a of the pump 30.

  The pulsatile flow sent out from the pulsatile flow forming device 31 flows into the right atrium 3 from the femoral vein portions 6, 6 → the abdominal vena cava portion 7 → the thoracic vena cava portion 8 through the flow paths L1 and L2. Then, it flows into the right atrium 3 from the superior vena cava 13 through the flow path L3. The pump 30 may be a constant capacity type.

  The pulsating flow forming device 31 is, for example, a device that gives pulsation by pressing a rubber tube connected to the discharge port 30a of the pump 30 at a constant cycle via a cam mechanism. Any pulsating flow forming device can be used, such as a device that applies a pulsation by rubbing a rubber tube connected to the outlet 30a with a roller disposed on the rotating disk at equal intervals. In this case, the pump 30 and the pulsatile flow forming device 31 function as pulsatile flow supply means.

  In addition to the above, a pulsating pump that rotates a rectangular rotor in a hollow cylindrical pump housing and extrudes fluid by movement of a gap between the rotor and the pump housing to form a pulsating flow is used. In this case, the pulsatile flow forming device 31 can be omitted. In this case, the pulsating pump functions as a pulsating flow supply means.

  The pulsatile flow that flows into the right ventricle 3a from the right atrium 3 is considered to have been sent from the pulmonary artery 14 to the lung (not shown), and then the upper right, lower right pulmonary veins 9, 10 and the upper left, lower left lung It returns to the left atrial part 4 through the vein parts 11 and 12, and returns to the pump 30 from the left atrial part 4 via the return flow path L4.

  Moreover, the flow path L5 connects the discharge port provided in the upper part and the lower part of the water tank 2, and the pump 30, The water which leaked in the water tank 2 from each said blood vessel part is returned to the pump 30, and the water tank 2 It is designed not to overflow.

4. Training Method Next, a training method for congenital heart disease surgery using the training device of the present invention will be described with reference to FIG.

  In performing the training, a predetermined atrial septal defect part is inserted from the part insertion part 5 and the blood vessel part is filled with water. A catheter introducer (not shown) is punctured at the end of the femoral vein 6.

  When the power of the pump 30 and the pulsatile flow forming device 31 is turned on, pulsation is given to the water discharged from the pump 30, and the pulsatile flow passes through the flow paths L1 and L2 (see FIG. 5), and the right atrium of the heart model 1 It is supplied to the unit 3 and further flows to the left atrial unit 4.

  A transesophageal echocardiogram is inserted from one end 17 a of the esophagus part 17 and moved to the vicinity of the heart model 1.

  While observing the echocardiogram, the direction of the transesophageal echocardiogram is adjusted so that the position of the defect hole 21a (see FIG. 3) is clearly reflected.

  Next, the delivery sheath 40 is inserted from the femoral vein portion 6 and approached to the defect hole portion 21a from the right atrial portion 3 side (see FIG. 6A).

  Under the echocardiogram using the esophagus part 17 and a fluoroscopic guide, the left atrial disk 40a of the device functioning as an obturator is expanded in the left atrial part 4 (see FIG. 6B).

  Next, the connecting waist portion 40b of the device is expanded (see FIG. 6C).

  Next, the device is pulled back to the atrial septum 20 and the connecting waist 40b is positioned in the defect hole 21a (see FIG. 6 (d)).

  Next, the delivery sheath 40 is pulled back while slightly pulling the delivery cable to expand the right atrial disc 40c and close the defect hole 21a (see FIG. 6 (e)).

  Next, it is confirmed that the periphery of the defect hole 21a is sandwiched between the left atrial disc 40a and the right atrial disc 40c, and the delivery sheath 40 is separated from the device.

  It is confirmed whether or not there is a fluid leak in the closed defect hole 21a.

  In this way, training for the treatment of congenital heart disease can be performed.

  The training device shown in the above embodiment is manufactured by imitating an atrial septal defect, but is not limited to an atrial septal defect, and a catheter is used to treat a defect such as a ventricular septal defect or an arterial wall defect. It can be applied to therapeutic training to obstruct.

  In addition, the training apparatus of the present invention can be used to evaluate devices because it can construct models according to various heart diseases.

1 heart model (congenital heart disease model)
2 Aquarium 3 Right atrium (compartment)
4 Left atrium (compartment)
5 Parts insertion part 6 Femoral vein part 7 Abdominal vena cava part 8 Thoracic vena cava part 9 Upper right pulmonary vein part 10 Right lower pulmonary vein part 11 Left upper pulmonary vein part 12 Left lower pulmonary vein part 13 Upper vena cava part 14 Pulmonary artery part 15 Pipe 16 Pipe 17 Esophageal part 18 Acrylic plate 19 Base 20 Atrial septal part 21 Atrial septal defect part 21a Defect hole part 30 Pump (pulsatile flow supplying means)
31 Pulsatile flow forming device (Pulsating flow supply means)
40 Delivery sheath 40a Left atrial disc 40b Connecting waist 40c Right atrial disc

Claims (6)

A congenital heart disease model in which two compartments are adjacent to each other via a septum, and the congenital heart disease is three-dimensionally reproduced by providing a hole in the septum;
Pulsating flow supplying means for causing fluid to flow into the two compartments and generating pulsation in the fluid flow, and
Furthermore, a training apparatus for treating congenital heart disease, characterized in that a part of the partition wall is composed of a detachable replacement part, and the hole is provided in the replacement part .   The congenital heart disease model according to claim 1, wherein the congenital heart disease model comprises a heart model simulating an atrial septal defect, and an esophagus portion simulating the esophagus is provided adjacent to the heart model. Training equipment for. The pulsatile flow simulating a venous system is connected to the heart model, and the pulsatile flow generated by the pulsatile flow supplying means is introduced into the heart model through the venous portion and discharged from the heart model. The training apparatus for congenital heart disease treatment according to claim 2 , wherein the training apparatus is configured to be fed back to the pulsatile flow supply means. The training apparatus for congenital heart disease treatment according to claim 2 , further comprising: a water tank that can accommodate the heart model, wherein the heart model is immersed in the water tank.   The training apparatus for congenital heart disease treatment according to claim 1, wherein the congenital heart disease model is made of a synthetic resin material having flexibility. A training method using the training device according to claim 1,
Prepare a heart disease model that three-dimensionally reproduces the heart disease by providing two compartments adjacent to each other via a partition wall and providing a hole in the partition wall,
In the two compartments, the fluid that causes pulsation by the pulsating flow supply means is flowed,
Producing a flow of fluid that moves in a short-circuit manner between the two compartments through the hole;
A training method for congenital heart disease treatment, which comprises training to close the hole using a capping device.