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Breeze Comes to Respect Life (4) - Minimally Invasive Replacement Valve Gives Patients a Second Life

Breeze Comes to Respect Life (4) - Minimally Invasive Replacement Valve Gives Patients a Second Life

  • Categories:News Channel
  • Author:
  • Origin:
  • Time of issue:2018-02-24 10:36
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(Summary description)

Breeze Comes to Respect Life (4) - Minimally Invasive Replacement Valve Gives Patients a Second Life

(Summary description)

  • Categories:News Channel
  • Author:
  • Origin:
  • Time of issue:2018-02-24 10:36
  • Views:
Information

  On February 11th, 2018, Zheng Dayi's Department of Cardiology and Outer Department of Prof. Xu Jing teamed up with Prof. Guo Yingqiang of the West China Hospital to complete the world's first apical aortic valve replacement + aortic valve "artificial chordae" angioplasty. Filled the gaps in the world of this field, broadened the TAVI indications, achieved very satisfactory results, and brought good news to elderly patients with severe valvular disease.

 

e

 

  Transapical aortic valve replacement (TAVI), through the apical approach, delivers the prosthetic heart valve to the aortic valve area to complete the prosthetic valve placement and restore valve function. The surgical trauma is small and recovery is quick. For patients who are at high risk or have contraindications to CPB surgery, this procedure is a safe and effective treatment.
  Medical History Information
  Mr. Guo Lao, 84, admitted to the hospital on the basis of "challenged chest tightness and palpitation for more than 10 years." In the past five years, the patient's heart function gradually depleted, his body gradually declined, he was unable to sleep on average, and was repeatedly hospitalized. Long-term use of dopamine, sodium nitroprusside, high-dose diuretics. The quality of life is very poor.

 

s

 

  1. Valvular heart disease Severe aortic valve insufficiency Mitral valve moderate insufficiency
  2. Arrhythmias
  3. Heart function class IV
  4. Hypertension
  5. Permanent pacemaker implantation
  6. After major prostate resection
  7. After varicose vein surgery

 

x

 

  Director Xu said that the elderly is 84 years old, heavier disease, complications, and high-risk patients. If you perform routine thoracotomy, the risk is too great. Finally, Director Xu proposed to perform minimally invasive valve replacement (TAVI) for the elderly.
  Surgical strategy
  Precise assessment of cardiac CT by cardiac surgery TAVI team: Contrast aortic annulus diameter 29.4mm in circumference, decided to adopt the maximum 29mm J-Valve? interventional valve for transapical TAVI surgery

 

s

 

  However, the patient's aortic valve ring is large. Once the valve is displaced, the consequences are unimaginable. After repeated discussions, the professors decided to boldly explore the “artificial sarcophagus” of the self-made aortic valve.
  Before the aortic valve was loaded, three 3-0 Prolen slides were used to suture and fix the prosthetic valve annulus. The other end of the slide wire was fixed on the introducer to lead out of the heart. After the valve is released, one end of the slide wire is fixed on the apical pad, which ensures the stability of the artificial valve.
  Surgical procedure
  (A): According to the preoperative design, self-made aortic valve "artificial chordae" loading artificial valve.

 

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  (B): Take a supine position, intravenous compound anesthesia, conventional disinfection shop towel, puncture the right femoral artery 6F pigtail catheter into the aortic sinus.

 

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  (C): left thoracic incision, open the pericardium, slip line plus a pad apical purse suture. After the apex was placed into the muddy guide wire and catheter. After catheterization to the distal descending aorta, the diarrhea guidewire was replaced with a hardened guidewire.

 

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  (D) Adjust the position and angle of the C-arm machine according to the preoperative CT measurement data so that the bottom of the three valve sinuses are displayed in the same plane.
  (E) Combining pre-operative CT and echocardiography measurements of the diameter of the annulus, the assembled 29mm J-valve valve was delivered along the stiffened guidewire above the aortic valve plane.

 

x

 

  (F): release the positioning device, in the aortic root imaging and pigtail catheter assisted positioning, retrace positioning parts, to ensure that the positioning member three anchors in the native valve sinus; interrupted root angiography guide, down the valve to the annulus plane, The valve stent is released and released from the delivery system.

 

x

 

  (seven): TEE and aortic root angiography showed that: Prosthetic valve position is appropriate, good function, good visualization of coronary artery, no significant paravalvular leakage and reflux.
  Professor Xu Jing of the Department of Cardiac Surgery combined Professor Li Bin of Anesthesiology Department, Nursing Officer Zhao Lanhai and Nurse Liang Yifan, Professor Zhong Zhongle of Department of Cardiology, Professor Lingyun Wang of Department of Ultrasound, Huang Mingjun and Zhao Yangchao of Life Support Center established a powerful Heart Team. The safety and efficiency of surgery.

 

c

 

  Postoperative
  After the operation, Mr. Guo Lao recovered well. The tracheal intubation was removed on the night. The postoperative review showed good results. He recovered and was discharged on February 24. The patient’s quality of life improved significantly and she regained her new life.

 

c

 

  Conclusion
  Department of health, life and care; knowledge changes fate, innovation and development, minimally invasive changes in life.
  On the basis of proficiency in routine surgery, Director Xu Jing believes that minimally invasive flap replacement (TAVI) can reduce trauma and relieve pain. He diligently studied, worked tirelessly, and repeatedly went to the top medical institutions at home and abroad to exchange learning.
  The minimally invasive valve replacement (TAVI) in this ward has greatly reduced postoperative complications and mortality, and will benefit the majority of cardiovascular patients in Henan in the future.
  Respect for life, life is worthy of respect, and can not be given up;
  The breeze came and put on this white coat.

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