A kind of supporting rod type bicuspid valve air bag closure plate occluder and implantation through apex of the heart implantationMethodTechnical field
The invention belongs to human heart recovery technique and medical instruments field, especially a kind of to repair heart bicuspid valve anti-The instrument of stream, specially a kind of supporting rod type bicuspid valve air bag closure plate occluder and method for implantation being implanted into through the apex of the heart.
Background technique
As shown in Figure 1, left ventricle 3 is located at 5 upper left side of the apex of the heart, bicuspid valve 2 is located at atrium sinistrum 1 and a left side for human heart and valveBetween ventricle 3, bicuspid valve 2 controls blood and unidirectionally flows into left ventricle 3 from atrium sinistrum 1.The bicuspid valve 2 of functional disturbance will lead to two pointsTwo leaflet incompetences of valve 2 make blood go back to atrium sinistrum 1 from 3 reflux of left ventricle in paradoxical expansion.Mitral regurgitation will causeStethemia and left ventricle 3 are loose, eventually lead to heart failure and the death of patient.
The structure of bicuspid valve 2 is as shown in Fig. 2, bicuspid valve 2 is the one-way valve structures of a complicated receiving blood pressure, by annulus2.1, the cardiac muscle composition on front leaflet 2.2, posterior valve leaflet 2.3, chordae tendineae 2.4, papillary muscle 2.5 and left ventricular wall.Papillary muscle 2.5 adheres toIn on left ventricular wall, front leaflet 2.2, posterior valve leaflet 2.3 are attached in annulus 2.1.Annulus 2.1 be a connection front leaflet 2.2, afterThe internal organizational structure of leaflet 2.3 and left ventricular wall.According to the institutional framework of annulus 2.1, the fiber of medial segment before it is divided intoThe muscle layer of layer and rear segmentum laterale.Chordae tendineae 2.4 originates in papillary muscle 2.5, is attached in leaflet, when can prevent heart contraction beforeLeaflet 2.2, posterior valve leaflet 2.3 collapse into atrium sinistrum 1.
State when normally functioning bicuspid valve is closed is as shown in Figure 3, Figure 4, front leaflet 2.2, back lobe after mitral valve closureIt is very close to each other between leaf 2.3, it is closed completely between front and back leaflet junction 2.6, reflux phenomenon will not be generated.When bicuspid valve 2 closesWhen state when conjunction is as shown in Figure 5, Figure 6, there are gap appearance, front and back leaflet knot between the front and back leaflet junction 2.6 of bicuspid valve 2Gap between 2.6 at conjunction makes blood flow back into (as illustrated by arrows 5 anti-of atrium sinistrum 1 from left ventricle 3 in heart contractionFlow direction), this reflux is known as mitral regurgitation, and mitral regurgitation can reduce cardiac efficiency and lead to heart failure.
Currently, mainly having annulus orthopedic, Mitral Mechanical or biological bicuspid valve for the treatment method of mitral regurgitationTransplanting etc., these need out chest, happy mostly, and big to human body wound, reliability is not high, cause after treatment 50% in 5 yearsMitral regurgitation recur again.Existing more advanced Minimal invasive procedures are by bicuspid valve clamp, by front and back leafletThe midpoint at edge is clipped together, and two independent channel of blood flow are formed, and reduces the reflux of blood, but this method has remnants anti-Stream occurs.
Summary of the invention
The problem of present invention aim to address existing mitral regurgitation treatment methods provides and a kind of plants through the apex of the heartThe supporting rod type bicuspid valve air bag closure plate occluder of the reparation mitral regurgitation entered, blocks mitral reflux channel, effectivelyPrevent mitral reflux；The present invention also provides the method for implantation of the strut-type air bag bicuspid valve closure plate occluder simultaneously, leads toIt crosses Minimally Invasive Surgery and is implanted to reflux hole site before and after bicuspid valve at leaflet closure, chest, happy is not needed out, to human body woundSmall, no remaining reflux occurs, high reliablity.
In order to reach the goals above, a kind of supporting rod type bicuspid valve air bag closure plate occluder being implanted into through the apex of the heart of the present inventionThe technical solution adopted is that: the supporting rod type air bag bicuspid valve closure plate occluder is by air bag closure plate, apex of the heart snap ring, positioningAxle sleeve, fixed plug and plug composition.The air bag closure plate is by support frame, air bag, support rod, check valve and woven hose groupAt；
There is an air bag inside the air bag closure plate, compresses to be placed into together and wear with support rod, support frame before implantationIt pierces with conduit implantation is punctured in conduit, implantation rear gasbag closure plate is located at heart two by being unfolded after perfusion tube inflation or filling liquidBetween two leaflet of cusp, obstruction treats mitral regurgitation because lesion generates mitral reflux channel；The support rod is skyThe hollow pipe with certain bending angle (15-30 °) of the heart, its one end are connected with air bag closure plate, and are embedded in air bag closureThe part of plate, insertion has through-hole to be connected with inside air bag, filling liquid or inflation convenient for perfusion tube, the other end and positioning shaft sleeve phaseEven；The support frame is located at air bag closure plate left and right sides edge, the sizing for air bag closure plate；The check valveInside support rod, it is connected with perfusion tube, prevents the liquid reflux of input air bag closure plate；Described perfusion tube one end and listIt is connected to valve, the other end is led in vitro by support rod, for air bag closure plate filling liquid or inflation；The apex of the heart snap ring canIt is fixed on apex of the heart position, prevents from being detached from from the apex of the heart；The lower end of the positioning shaft sleeve and support rod is connected by a hinge, for fixedPosition air bag closure plate, can low-angle swing and rotation；The fixed plug is located at outside the apex of the heart, and positioning shaft sleeve is consolidatedIt is scheduled on apex of the heart snap ring, the plug is connected with fixed plug, for the sealing of left ventricle, prevents blood from flowing out.
Preferably, support rod connects one layer of good thin-film material of blood compatibility of outer bread with positioning shaft sleeve.
Preferably, the shape after the expansion of air bag closure plate is that radial position has the radian plate of 5-10 degree, closure plate intermediate thin,The right and left is thick, and the thickness of the right and left is different.
The technical side that the method for implantation of the supporting rod type bicuspid valve air bag closure plate occluder through apex of the heart implantation usesCase are as follows: be implanted by apex of the heart position small notch on the left of chest, enter left ventricle through the apex of the heart, air bag closure plate is placed on front and back leafletJunction, air bag closure plate is fixed on apex of the heart position by support rod, the specific steps are as follows:
A, a small notch is done in chest left heart apex of the heart position, leads directly to the apex of the heart, do a pocket operation in apex of the heart position；
B, in vitro, first by air bag closure plate, support frame, support rod, positioning shaft sleeve, closure plate operating stick and insideCheck valve and after perfusion tube assembles, compression, which is placed into, to be punctured in conduit, then, the apex of the heart card on puncturing conduit external mountingRing, snap ring operating stick；
C, the puncture conduit for assembling apex of the heart snap ring and snap ring operating stick is reached into apex of the heart position through left side thoracic wall small incision,It is punctured from the pocket that apex of the heart position sutures by puncture conduit and enters left ventricle, then pushed away apex of the heart snap ring by snap ring operating stickInto the cardiac muscle of the apex of the heart, apex of the heart snap ring is fixed on apex of the heart position by pocket of tying tight；
D, snap ring operating stick is withdrawn from, closure plate operating stick is adjusted and punctures conduit, by air bag closure plate from puncture conduitIt releases, after adjusting positioning shaft sleeve is located at apex of the heart snap ring position, withdraws from puncture conduit, and fixed plug is mounted on apex of the heart snap ring lower endScrew thread on；
E, it is inflated by perfusion tube into air bag closure plate, makes its molding, then withdrawn from perfusion tube or from positioning shaft sleeveIt cuts lower end；
F, plug is mounted on the screw thread of positioning shaft sleeve, suture left side thoracic wall small incision, operation finishes.
The present invention has the advantage, that afterwards by adopting the above technical scheme
(1) bicuspid valve air bag closure plate of the present invention is made of the good material of blood compatibility, can before inflationThe very little that compression becomes diameter is placed into and punctures in conduit, is implanted by thoracic wall small incision on the left of human body, enters the left heart through the apex of the heartRoom is positioned and secured to the reflux hole site at the leaflet closure of bicuspid valve front and back, and when diastole, bicuspid valve is opened, bloodLeft ventricle is flowed into from atrium sinistrum by the two passes between forward and backward leaflet and air bag closure plate；When the heart contracts, forward and backwardLeaflet is closed, and leaflet edge and air bag closure plate closely adhere to together, block mitral reflux channel, be effectively preventedMitral reflux.
(2) structure of air bag closure plate occluder is simple, highly reliable, and method for implantation is small to the wound of human body, remainingReflux incidence is very low, is able to carry out the treatment of the diseases such as functional mitral valve insufficiency, repair function type mitral regurgitationSuccess rate is up to 90% or more.
Detailed description of the invention
With reference to the accompanying drawing and specific embodiment the present invention is further illustrated, but protection scope of the present inventionIt is not limited to this.
Fig. 1 is the structure and mitral valve position figure of heart；
Fig. 2 is mitral institutional framework enlarged drawing in Fig. 1；
Right side view when Fig. 3 is mitral valve closure in Fig. 2；
Atrial side partial enlarged view when Fig. 4 is mitral valve closure in Fig. 2；
Fig. 5 is the right side view of mitral regurgitation when Fig. 2 cardiac shrinks mitral valve insufficiency；
The atrial side partial enlarged view of mitral regurgitation when Fig. 6 is Fig. 2 cardiac contraction mitral valve insufficiency；
Fig. 7 is of the present invention a kind of after the bicuspid valve air bag closure plate occluder implantation of the supporting rod type of apex of the heart implantationSchematic diagram (front)；
Fig. 8 is the 3-D view after the expansion of air bag closure plate；
Fig. 9 is the structural schematic diagram of air bag closure plate implant part；
Figure 10 is instrument installation diagram before the minimally invasive implantation of air bag closure plate；
Figure 11 is the position view (side) after the implantation of air bag closure plate.
In figure: the atrium sinistrum 1-, 2- bicuspid valve, 2.1- annulus of mitral valve, 2.2- front leaflet, 2.3- posterior valve leaflet, 2.4- chordae tendineae,2.5- papillary muscle, the front and back 2.6- leaflet junction, 3- left ventricle, 4- aorta petal, the 5- apex of the heart, 6- air bag closure plate, 6.1- branchSupport bone frame, 6.2- air bag, 6.3- support rod, 6.4- check valve, 6.5- perfusion tube, the fixed plug of 7-, 8- positioning shaft sleeve, 9- apex of the heart cardRing, 10- plug, 11- snap ring operating stick, 12- closure plate operating stick, 13- puncture conduit.
Specific embodiment
Referring to Fig. 7 and Fig. 9, a kind of structure of the supporting rod type bicuspid valve air bag closure plate through apex of the heart implantation of the present invention includesAir bag closure plate 6, fixed plug 7, positioning shaft sleeve 8, apex of the heart snap ring 9, plug 10.The air bag closure plate 6 is by support frame6.1, air bag 6.2, support rod 6.3, check valve 6.4, perfusion tube 6.5 form.Before being placed on bicuspid valve after the implantation of air bag closure plateIt between posterior valve leaflet (2.2,2.3), is formed by support frame 6.1, is poured by check valve 6.4 and perfusion tube 6.5 into air bag 6.2Gas or liquid molding.Air bag closure plate 6 is linked together by following support rod 6.3 and positioning shaft sleeve 8, is used for closure platePositioning.
The support rod of positioning shaft sleeve 8 and air bag closure plate 6 links together, and for the positioning of closure plate, can make to be closedPlate has the swing and rotation (5-10 degree) of certain angle.Positioning shaft sleeve 8 is fixed on fixed plug 7 by plug 10.
Fixed plug 7 is connected with apex of the heart snap ring 9, for the positioning of apex of the heart snap ring 9, prevents apex of the heart snap ring toward one sidesway of ventricleIt is dynamic, and be connected with positioning shaft sleeve 8, positioning shaft sleeve 8 is fixed on apex of the heart snap ring 9.
Barb structure is arranged at 9 outer ring top of apex of the heart snap ring, prevents apex of the heart snap ring 9 from deviating from outward from the apex of the heart 5, passes through fixed plug 7Apex of the heart snap ring 9 is firmly fixed on the apex of the heart 5.
Positioning shaft sleeve 8 is fixed on fixed plug 7 by plug 10, for air bag closure plate 6 the apex of the heart positioning, and it is airtightEnvelope effect prevents the blood in left ventricle 3 from leaking by apex of the heart snap ring 9.
Referring to Figure 10 and Figure 11, the method by the minimally invasive implantation left ventricle of the supporting rod type bicuspid valve air bag closure plate is:
Step 1, a small notch is done in apex of the heart position on the left of chest first, leads directly to the apex of the heart 5, and do in 5 position of the apex of the heartOne pocket operation, the positioning for apex of the heart snap ring 9.
Step 2, as shown in Figure 10, in vitro exists air bag closure plate 6 and positioning shaft sleeve 8, the assembly of closure plate operating stick 12Together, compressing gasbag closure plate 6 makes itself and positioning shaft sleeve 8, closure plate operating stick 12 be placed into puncture in conduit 13 together, wears13 outside of thorn conduit and apex of the heart snap ring 9 and snap ring operating stick 11 are assembled together.
Step 3, the puncture conduit 13 (Figure 10) that will be assembled reach the apex of the heart by the small notch of left side chest over titie heart apexPosition in vitro, punctures among the pocket of suture and enters left ventricle, adjusts snap ring operating stick 11, apex of the heart snap ring 9 is made to fill in the heartIn the cardiac muscle of point 5, pocket of tying tight is fixed by apex of the heart snap ring 9.
Step 4 withdraws from snap ring operation 11, and by closure plate operating stick 12, air bag closure plate 6 is pushed away from puncture conduit 13Out, and by closure plate operating stick it adjusts, after so that positioning shaft sleeve 8 is located at 9 position of apex of the heart snap ring, withdraws from and puncture conduit 13, and willFixed plug 7 is mounted on the screw thread of 9 lower end of apex of the heart snap ring.
Step 5 is inflated by perfusion tube 6.5 into the air bag 6.2 of air bag closure plate, makes its molding, then by perfusion tube6.5 withdraw from or cut from 8 lower end of positioning shaft sleeve.
8 lower thread of positioning shaft sleeve is passed through 7 lower section circular holes of fixed plug by step 6, and plug 10 is mounted on positioning shaft sleeve 8Screw thread on, be fixed on it on fixed plug 7.
Step 7, suture left side thoracic wall small incision, operation finish.