一种新的大鼠同种主动脉瓣异位移植模型

目的 探讨建立一种主动脉瓣异位移植动物模型，用于研究同种心脏瓣膜的保存。方法 受体供体均采用雌性Wistar大鼠，各40只。整块切取受体心脏。保留完整的t动脉瓣、少量心室肌和部分二尖瓣前叶，构建移植物。将移植物与受体腹主动脉端一侧吻合。结果 术后28d，80％受体存活，无下肢瘫痪，移植物搏动良好，切开移植物肉眼观未见血栓，主动脉瓣位于正常位置且活动良好。受体死亡原因有血栓栓塞（12．5％）、术中出血（5．0％）和麻醉意外（2．5％）。结论 此模型可广泛应用于同种心脏瓣膜保存方法等研究，是较理想的模型。     

A fully echo-guided trans-apical aortic valve implantation

The trans-apical aortic valve implantation (TA-AVI) is an established technique for high-risk patients requiring aortic valve replacement. Traditionally, preoperative (computed tomography (CT) scan, coronary angiogram) and intra-operative imaging (fluoroscopy) for stent-valve positioning and implantation require contrast medium injections. To preserve the renal function in elderly patients suffering from chronic renal insufficiency, a fully echo-guided trans-catheter valve implantation seems to be a reasonable alternative. We report the first successful TA-AVI procedure performed solely under trans-oesophageal echocardiogram control, in the absence of contrast medium injections.     

Severe aortic insufficiency after transapical aortic valve implantation

We report the dislocation of a stented aortic valve prosthesis two weeks after the uneventful transapical implantation in a female who had underwent mitral valve replacement and CABG six years before. The initial implantation of the Edwards Sapien aortic valve prosthesis (Edwards Lifesciences, Irvine, CA), as well as the postoperative recovery, was uneventfully. At the sixth postoperative day, the patient developed a progressive heart failure due to a severe aortic insufficiency. During conventional aortic valve replacement, the dislocated prosthesis was found in the left ventricle. After uncomplicated postoperative recovery, the patient could be discharged in a good physical condition. Preexisting mitral valve prosthesis seems to be an important, complicating goal for transcatheter aortic valve implantation.     

经导管植入国产自膨式主动脉瓣膜治疗老年性主动脉瓣狭窄(附3例报告)

正75岁以上的老年人退行性心脏瓣膜病发病率高达4.6%~([1])。老年性主动脉瓣狭窄(aortic valve stenosis,AS)发病率越来越高。目前外科主动脉瓣膜置换术(surgery aortic valve replacement,SAVR)仍是治疗重度AS的首选方法,但30%~50%的患者因存在严重合并症、无法承受外科手术而出现心力衰竭和心源性猝死。2002年Cribier等~([2])采用经导管主动     

Permanent pacemaker implantation after transapical transcatheter aortic valve implantation

The aim of the study was to determine the incidence of permanent pacemaker implantation (PPMI) in a cohort of 358 patients undergoing transapical aortic valve implantation (TAVI) using a balloon-expandable prosthesis between April 2008 and March 2011. After excluding patients who had had a previous PPMI (n=36; 10%), the study group consisted of 322 patients. These were divided into two groups: patients who required PPMI (PPM group) and patients who did not require it (non-PPM group). Preoperative, perioperative and one-year follow-up data were collected prospectively. Twenty (6.2%) patients required PPMI. Previous implantation of an aortic prosthesis (P=non-significant), previous coronary artery bypass grafting (P=0.05) and coronary artery disease (P<0.005) were more common in the non-PPM group. On logistic regression, only patient age seemed to be correlated to PPMI (P=0.05, odds ratio 1.08; CI 0.9-1.1). There was no difference in survival rate between the groups after 30?days (PPM group 95%, non-PPM group 93.6%). Similarly, the survival rate did not differ after one year (PPM group 84%, non-PPM group 80.9%; P=0.3). The PPMI rate after transapical TAVI using a balloon-expandable prosthesis is thus low, and has no impact on early and follow-up mortality.     

Inverted valve after initially successful transfemoral aortic valve implantation

A 73-year-old woman with severe aortic stenosis was accepted for transcatheter aortic valve implantation. There was minimal paravalvular leakage after the implantation, and the patient was stable. Twelve minutes after the implantation, the arterial pressure suddenly dropped. Transesophageal echocardiography showed severe left ventricular dysfunction. Cardiopulmonary resuscitation was started, and initially was successful with a systolic blood pressure of 90 mm Hg. However, despite initiation of extracorporeal circulation support, the patient deteriorated, pulmonary edema developed, and she died. Autopsy revealed an inverted aortic valve. The reasons why the patient had cardiac arrest and an inverted transfemoral aortic valve remain unclear.     

Transcatheter aortic valve implantation in Jehovah's Witness patients with symptomatic severe aortic valve stenosis

Transcatheter aortic valve implantation (TAVI) is currently reserved for high or prohibitive surgical-risk patients with aortic valve stenosis. We report on successful TAVI in two Jehovah's witness patients. It offers a simple and effective treatment of severe aortic valve stenosis in high-risk patients who refuse the use of allogeneic blood and blood products.