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Shandong Qianfoshan Hospital heart team successfully completed the hospital's first case of apical TAVI surgery

Shandong Qianfoshan Hospital heart team successfully completed the hospital's first case of apical TAVI surgery

  • Categories:News Channel
  • Author:
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  • Time of issue:2018-01-01 11:29
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(Summary description)

Shandong Qianfoshan Hospital heart team successfully completed the hospital's first case of apical TAVI surgery

(Summary description)

  • Categories:News Channel
  • Author:
  • Origin:
  • Time of issue:2018-01-01 11:29
  • Views:
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  On December 3, 2017, TAVI team from Qianfoshan Hospital successfully completed a transcatheter aortic valve replacement (TAVI) under Wang Dong, director of the 4-Cardiovascular Department of Qianfoshan. Jiecheng Medical will bring a wonderful review of surgery.
  Patient history data

  Suffering from previous history of hypertension for 30 years, blood pressure up to 180 / 80mmHg. History of intestinal obstruction, 22-year line, surgical treatment, specifically unknown, 25 years ago, subtotal gastrectomy, appendectomy four years ago, denied the history of chronic diseases such as diabetes, chronic bronchitis, history of infectious diseases such as hepatitis, tuberculosis and denied Its close contact with history, blood transfusion history, specifically unknown, denied major trauma and other major surgery, found no history of food and drug allergies, vaccination history.

  ▌ heart valve disease: aortic stenosis (severe), mild aortic regurgitation, mild tricuspid regurgitation, heart function level IV. Coronary atherosclerotic heart disease, unstable angina, after PCI. 3. Hypertension, 3, very high risk. 4. Subtotal gastrectomy. Postoperative intestinal obstruction. Appendectomy.

  Surgical strategy

  ▌ Preoperative, the Ministry of Health organizes extra-cardiac, intracardiac, imaging, anesthesia and nursing experts conducted multidisciplinary consultations, from the diagnosis and treatment measures to surgical risk, complications, anatomy, surgical approach, prevention of complications All aspects of in-depth analysis and discussion, and patients and their families fully informed informed consent, and ultimately determine the choice of TAVR for the patient's preferred program. After heart Team accurate CT assessment, discussed many times, the final decision to use 27mm J-Valve? interventional valve trans-TAVI surgery.

 

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  Surgical procedure

  ▌ Operation time: December 3, 2017
  Surgical procedure (a): take supine position, conventional disinfection shop towel, intravenous composite anesthesia, puncture the left radial artery to monitor blood pressure. Puncture the right femoral vein, implanted temporary pacing lead to the right apex of the heart.
  Surgical procedure (b): The right femoral artery was punctured into a 6F pig tail catheter and then aortic blood pressure was monitored. According to the previous CT measurement data to adjust the position of the C arm so that the three valve sinus simultaneously displayed and in the same plane. Do a left chest incision, open the pericardium, apex purse suture, and set aside 6 pads. Implantation of the J-Tip soft guide wire into the ascending aorta after apical puncturing was performed through the guide wire into the JR4 guide catheter. The guide wire is guided to the distal end of the descending aorta. Replace 1.8m ultra-slip hard wire. Remove the JR4 catheter.
  Surgical procedure (c): Exchanging 260 mm Amplasz super-hard guidewire, dilated apical puncture with dilatation sheath. Delivered to a NuMed 23 × 4 mm balloon for pre-dilatation at the aortic valve.

 

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  Surgical Procedures (IV): Combined with preoperative CT and ultrasonographic measurements of valve annulus diameters, a 25 mmJ-Valve? valve was assembled and delivered along a stiff guide wire to a valved catheter delivery system above the plane of the aortic valve.

 

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  Surgical procedure (e): In the pig tail catheter assisted positioning, assisted by aortic root apexography to release the positioning member to ensure that the positioning member is located in the autologous valve sinus, the valve down to the annulus plane, open the valve stent, the stent after the release of catheter delivery System, pig tail catheter aortic root angiography showed: artificial valve position, open well, the coronary ostial was not affected, no paravalvular leakage and reflux. TEE and aortic rootography showed mitral valve opening and closing is not affected, artificial aortic valve works well.

 

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  The J-valve? Interventional Bio-heart Valve is a new generation of interventional valves that was approved for clinical use by the State Food and Drug Administration in April 2017. Its indications include aortic valve stenosis, aortic regurgitation and aortic valve stenosis Closure of the incomplete, is currently the world's only officially approved to treat aortic valve regurgitation interventional valve, but also a one-stop solution of aortic valve disease.

 

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