Method for surgical correction of paraprosthetic endocarditis of atrioventricular valves

FIELD: medicine, cardiosurgery.

SUBSTANCE: the method deals with valvular reprosthetics. After dissecting a prosthesis and treating infectious foci with antiseptics it is necessary to implant a carcass xenoprosthesis faced with epoxy-treated xenopericardium. At implanting xenoprosthesis into mitral position it should be fixed in position of fibrous ring by separate P-shaped sutures, one part of which could be upon interlayers. At implanting xenoprosthesis into tricuspid position it should be fixed in position of fibrous ring, moreover, septal valve should be fixed with separate P-shaped sutures, anterior valve - in the middle with a single P-shaped suture, The rest length of xenoprosthesis should be fixed with uninterrupted blanket suture.

EFFECT: decreased chance for prosthetic infectioning.

2 ex

 

The present invention relates to medicine, namely to surgery, and can be used for the surgical treatment of preprocessor endocarditis of the mitral and tricuspid valves.

There is a method of surgical treatment preprocessor endocarditis atrioventricular valves, which includes reputazione valve, a sleeve which is treated with antiseptics.

However, the prototype has several shortcomings.

1. remains cuff mechanical prosthesis;

2. when applying xenoclone remains an artificial cloth, which covered the frame of the prosthesis.

That is, the substrate for infection in cells of tissue basis with the formation of the infectious focus, which again will lead to relapse preprocessor endocarditis with possible formation of blood clots, abscesses, fistulas.

To eliminate these disadvantages of the proposed method of surgical treatment preprocessor endocarditis, wherein the lacing xenoclone used artificial fabric, and kenopanishad treated with epoxy compounds, which gives xenotime more resistant to infection compared to glutaraldehyde processing. While surgical correction preprocessor endocarditis frame xenoprostheses sheathed epoxybutane xenopi what ARD, allows you to achieve a positive therapeutic effect.

The method is carried out in the following sequence.

1. Access to the heart of the middle or right anterolateral thoracotomy.

2. Selection of major vessels.

3. Providing "dry" heart - aspertosina hypothermic protection or artificial circulation.

4. Access to the atrioventricular valve.

5. Excision of the valve prosthesis.

6. The execute method.

7. Restoration of adequate cardiac activity.

After you complete access to the heart proceed to the selection of major vessels according to the method, not different from the well-known. Further, provision of the terms "dry" heart, or in conditions aspertaine hypothermic protection through occlusion of major vessels, or in extracorporeal circulation according to the standard technique. Intracardiac stage start with a revision of the cavities of the heart and atrioventricular prostheses. The prosthesis is excised. Found pockets of infection (abscesses, ulcers surface and the like) are treated with antiseptic solutions. In the position of the fibrous ring of mitral valve frame xenoport sheathed epoxybutane xenopericardium, implanted on a separate U-shaped seams, some of which may be on the gaskets to avoid the eruption of the joints). In the ositio the annulus of tricuspid valve: on the perimeter of the septal fold - a separate U-shaped seams on the middle of the perimeter of the front fold - single U-shaped seam on the rest during a continuous blanket. Sealing of cavities and restore adequate cardiac activity.

An example of implantation in the mitral position.

Patient O., 57 years old, and a/b No. 3751/01. Entered the Novosibirsk research Institute of circulation pathology, 6 August 2001 In April 2001, was operated at the research Institute PC about badly formed mitrale-aortic defect on the background of active infective endocarditis. Made prosthetic aortic valve with xenoprostheses “Kemerovo-AB-mono-25”, mitral - “Kamkor-30”. In crops is Staphylococcus aureus. The postoperative period was characterized by a pronounced activation of the infectious process. At discharge activity process laboratory data - Art. II 29.07.01 sharp deterioration: severe weakness, shortness of breath, heart palpitations.

In the clinic of the research Institute PC diagnosed with primary infective endocarditis, activity II senior Fistula mitral prosthesis. The operation of prosthetic mitral and aortic valves (April 2001). N II B.

Echocardiography. MK: the shadow of the biological prosthesis is running normally, the amplitude of movement of the locking element 15 mm, peak diastolic gradient of 27 mm Hg (average - 6.7), Applewood 3.4 cm2. Between the wall series the CA and braided prosthesis is logged reset in the left atrium volume closer to full-blown. PL see 5.8 AOK - edge folds unevenly thickened, with their level register the reverse jet volume is insignificant.

The presence periannular fistula mitral prosthesis with a significant amount of discharge, MK II B, require defect correction for health reasons, despite the activity of infective endocarditis II Art.

August 24, 2001 the operation: reputazione frame xenoprostheses Kemerovo production, sheathed epoxybutane xenopericardium. Operations: fistula of prosthetic mitral valve in the projection of the back door, where it was revealed abscess of the fibrous ring and the back door, not icecaves operations, over 1/2 of the perimeter of the prosthesis. The rest of the braid prosthesis endothelization. The prosthesis isseen. Implanted frame xenoport Kemerovo production, sheathed epoxybutane xenopericardium.

The postoperative period was complicated by development of the syndrome in Frederick, about which 31.08.01 implanted EX-300 in endocardial variant in the VVI mode (demand). Effective treatment, at discharge, the minimum degree of activity of the process. Control Echocardiography: function bioprocesos not violated. Vegetation on the prosthetic is not revealed.

Control examination after 9 months: complaints are minimal. The activity of the inflammatory process in the laboratory Yes the s' - minimalna. Function bioprocesos adequate. On Echocardiography signs of inflammation no vegetation not identified.

Just in mitral position with active infectious endocarditis implanted 2 frame xenobiotica Kemerovo production, sheathed epoxybutane xenopericardium,. In all cases, the positive therapeutic effect.

An example of implantation in the tricuspid position.

Patient T., 27 HP, and a/b No. 3709/02. Entered the Novosibirsk research Institute of circulation pathology, 15 July 2002, fell Ill in December 2000, was treated at the place of residence regarding infective endocarditis. In the same year diagnosed with tricuspid defect (failure). In 2001, NII PC made prosthesis tricuspid valve by xenoprostheses “Kamkor-32”. Felt satisfactorily until August 2001, when there was a worsening of infectious endocarditis. Antibiotic therapy is ineffective. From may 2002 resuming fever (up to 40°C), increased shortness of breath, reduced tolerance to stress.

In the clinic of the research Institute PC diagnosed parapertussis tromboendocardyt I-II century act. Dysfunction of the prosthesis tricuspid valve. The operation of the prosthetic tricuspid valve by xenoprostheses “Kamkor-32” in 2001 NC CB (III FC NYHA).

Echocardiography. TRC: the shadow of the biological prosthesis, on the atrial surface of the criss-crossing and prosthesis register additional floating echoes 3,1· 3.3 mm, 4,4·5.0 mm, 10,9·2.6 mm, EF. the area of 1,6-1,82 cm2, diastolic gradient 18.6 mm Hg, regurgitation is not defined. In the cavity of the right ventricle visualized parietal additional echo signals passing in the projection of the annulus.

The presence of dysfunction of the prosthesis, leading to significant hemodynamic changes, circulatory insufficiency 2 b Art. require defect correction despite the activity of infective endocarditis 1-2 tbsp.

July 18, 2002, executed operation: reputazione tricuspid valve frame xenoprostheses Kemerovo production, sheathed epoxybutane xenopericardium. Operations: folds prosthesis gray-yellow, almost motionless. Closer to the free edge, on the atrial surface - vegetation, thrombotic deposition. The prosthesis isseen. On the ventricular surface of one of the doors is mixed thrombus 2·1.5 cm Made of reputazione tricuspid valve.

The postoperative period was characterized by the activation of infective endocarditis. Effective treatment, at discharge, the minimum degree of activity of the process. Control Echocardiography: function Bioprocess not disturbed, vegetation on the prosthesis was not detected.

When active preprocessor endocarditis in tricuspid position implanted 1 frame KS is noprocess Kemerovo production, sheathed epoxybutane xenopericardium. Received positive direct therapeutic effect.

Thus, for the treatment of active preprocessor endocarditis atrioventricular valves were implanted 3 frame xenobiotica sheathed epoxybutane xenopericardium (2 - in mitral position, 1 in the tricuspid position). In all cases, the positive therapeutic effect.

A method of surgical correction preprocessor endocarditis atrioventricular valves, including reputazione valve, characterized in that after excision of the prosthesis and treatment with antiseptics foci of infection are implanted frame xenoport sheathed epoxybutane xenopericardium, during implantation of xenobiotica in mitral position it is fixed in the position of the annulus to separate the U-shaped seams, some of which may be on the gaskets after the implantation xenobiotica in tricuspid position it is fixed in the position of the annulus, while the septal flap is fixed with a separate U-shaped seams, the front flap is in the middle of a single U-shaped seam on the rest during xenoport continuous record blanket stitch.



 

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