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.


Same patents:

FIELD: medicine.

SUBSTANCE: method involves arranging testee and additional valves in system circulation canal with parameters of working liquid flow having physiological values. The working liquid has blood viscosity. Hemolysis degree is determined from changed elastic stress relaxation time in working liquid samples taken in course of the experiment. Preliminary tests are carried out with several additional valves of different hemolytic properties under working liquid flow parameters being fixed. Total hemolysis degree is measured in various combinations of mounted additional valves in circulation system canal. After having solved a linear equations system, hemolysis degree values as contributions caused by circulation system and additional valves. Hemolysis degree of a valve under test tested in combination with one of additional valves is calculated from a formula ΓNΣ0add, where ΓΣ is the total hemolysis degree, Γ0 is the hemolysis degree contributed by circulation system, Γadd is the hemolysis degree of additional valve used.

EFFECT: high accuracy in determining hemolysis degree.

1 dwg

FIELD: medical engineering.

SUBSTANCE: device has connection member manufactured from absorbable material connected to thread on one of its ends. The thread transmits longitudinal pulling force for introducing the connection member into valve ring tissue to set up it therein. The second device embodiment has different needle design. The needle is introduced into endomyocardium of valve ring and brought through a part of the opening perimeter. The needle is brought out and the connection member is introduced into endomyocardium by means of the thread in a way that free end of the connection member is to be at introduction point. The connection member is fixed in the endomyocardium and brought through the ring to the position characterized in that the other end is located in removal point and exits in this way from the endomyocardium. The second end is fixed.

EFFECT: normalized valve ring growth in children.

29 cl, 9 dwg

FIELD: medical engineering.

SUBSTANCE: device has cylindrical body and locking disk member mounted therein with rotation about axis displaced relative to diameter being in parallel to it. Disk member center of gravity is deviated relative to its geometrical center and set so that its rotation axis passes through the center of gravity and the member itself is engageable with opposite device body ends in closed state. The device body has locking disk member stroke stopper manufactured as prominence located between the locking disk member rotation axis and device body diameter arranged in parallel to the rotation axis.

EFFECT: enhanced effectiveness of operation; reduced force magnitude needed for opening the locking member; maximum effective cross-section in open position.

6 cl, 1 dwg

FIELD: medical engineering.

SUBSTANCE: device has ring-shaped body, fixing members 3 manufactured as protrusions and rotatable cusps mounted in the ring-shaped body. Slots are available on lateral surfaces of body fixing members mainly arranged along central axis of the device body. Protrusions are available on lateral surfaces of slots produced on lateral surfaces of cusp. The protrusions are engageable with slots in device body.

EFFECT: higher thrombus formation resistance.

6 cl, 5 dwg

FIELD: medical engineering.

SUBSTANCE: device has body having external and end face surfaces and envelope box cuff. Locking member is mounted in the device body. The locking member is connected to the device body by means of rotation unit of hinge type. External surface of the device body has ring-shaped protrusion having fitting and supporting surfaces. The envelope box is collapsible and detachable. It has bushing and ring having smooth or threaded connection between them. The device body has two external surface areas free of the cuff adjacent to end face surfaces of the body.

EFFECT: high reliability and long service life.

4 cl, 3 dwg

FIELD: medical engineering.

SUBSTANCE: device has two leaflets. The leaflets are mounted on finger member allowing rotation about artery axle and have working ends and shank. The working ends have fitting surfaces restricted with thrusting and holding ribs. A holding rib has internal and external end surface. The external end surface of holding rib of each leaflet has protrusions having centering surfaces manufactured as portions of the same revolution surface having diameter of Dc. Revolution surface axis coincides with the central axis of the holder.

EFFECT: excluded valve displacement relative to fibrous ring; reduced risk of canal dysfunction; improved long-term prosthetic operation results.

3cl, 4 dwg

FIELD: medical engineering.

SUBSTANCE: device is designed as flexible hose segment of flat cross-section enveloping base member manufactured as circular or oval ring. The opposite end is left free. The valve has an additional member like supporting plate (contour frame or contour loop) rigidly fixed on the base member and embraced with free end of the flexible hose. To achieve better conditions for blood flow to wash working member surface, the member is perforated in zone of its attachment to the base member. To achieve better biocompatibility conditions, valve member is manufactured from natural patient blood vessel.

EFFECT: high operation reliability and reduced hemolysis.

4 cl, 2 dwg

The invention relates to medical equipment and can be used in heart surgery to replace a diseased natural heart valves person

The invention relates to the field of medicine

The invention relates to medical equipment, namely, devices for installation of the aortic valve or frameless Bioprocess of the aortic valve for bench research in pulsating flow of biomechanics and hydrodynamics of native (allogeneic, xenogeneic) valves of the aorta and frameless substitutes (allografts, xenografts)

FIELD: medicine, surgery.

SUBSTANCE: one should lift anterior abdominal wall in the course of laparoscopic operations due to traction by fixing ligatures which should be fixed either at a trocar or an arch above operation table.

EFFECT: more simplified technique for laparolifting.

1 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: mastectomy should be performed due to subareolar access, the wound should be drained and sutures should be applied. For the purpose to shorten therapy terms and improve cosmetic result one should mobilize full-layer superior and inferior fragments, suture subcutaneous fiber of both fragments with separate interrupted sutures in horizontal direction, replace the developed excess of superior fragment with mammilo-areolar complex onto the skin, mark its borders and deepithelize inferior fragment along its new contour. Then one should apply cutaneous sutures. The method enables to shorten terms for wound healing.

EFFECT: improved cosmetic result.

5 dwg, 1 ex

FIELD: medicine, surgery.

SUBSTANCE: one should apply a drainage tube onto isolated stump of Santorini's duct to be then fixed by ulcerous crater's bottom. The second drainage tube should be put on the first one to be fixed by the edge of ulcerous crater. Crater and drainage tube on it should be hermetically sealed with omentum by including proximal end of the second drainage tube. One should perform segmental duodenoplasty. The method suggested enables to protect pancreas against intraductal hypertension in early post-operational period and prevent the onset of pancreatitis and pancreonecrosis.

EFFECT: higher efficiency of therapy.

8 dwg, 1 ex

FIELD: medicine, orthopedics.

SUBSTANCE: the method deals with applying compression-distraction apparatus consisting of rings and a square framework supplied with distraction rods and cantilevers in its grooves followed by applying and fixing the needles and osteotomy of the first metatarsus. The novelty lies in the fact that a needle with a soldered piece applied through proximal metaphysis of the first metatarsus from the bottom upwards should be fixed in inferior grooves of the framework; needles with soldered pieces applied from the bottom upwards through distal metaphysis of the first metatarsus and diaphysis of distal phalanx of the great toe should be fixed to distraction rods being fixed in the upper grooves of the framework; a needle with a soldered piece applied from the bottom upwards through distal metaphysis of the fourth metatarsus should be fixed in cantilevers at inferior grooves of the framework along with removing adduction of anterior department of patient's foot by replacing the framework in frontal plane from inside outwards, and lengthening the first metatarsus by shifting its osteotomized fragment in distal direction that decreases tissue traumatism due to simultaneous lengthening capsular-ligamentous apparatus along median surface of patient's foot, eliminating the shift in the first metatarso-wedge and navicular-wedge joints and removing the shortening in the first metatarsus.

EFFECT: higher efficiency of therapy.

1 dwg, 1 ex

FIELD: medicine, orthopedics.

SUBSTANCE: the present innovation deals with treating varus deformation of collum femoris of different etiology combining with cervico-epiphyseal deformation of cervical shortening with the help of the means of perosseous fixation. The method includes destruction of femoral integrity, application of perosseous device to fix osseous segments and dosed traction of osseous fragments. For this purpose one should perform C-shaped osteotomy in trochanterian area, perform single adduction of distal osseous fragment followed by its further dosed shift downwards and outwards. Moreover, if necessary, one may perform correction of torsion femoral deformation due to rotating distal osseous fragment along femoral axis that provides simultaneous correction of cervico-diaphyseal angle and removed cervico-epiphyseal deformation and shortening of patient's collum femoris.

EFFECT: higher efficiency of therapy.

1 cl, 7 dwg, 1 ex

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: one should remove metal constructions pre-applied through area of distal tibiofibular syndesmosis to press patient's foot in central direction along shin's longitudinal axis. Shin-foot segment should be fixed with a bandage followed by loading onto affected limb at walking to prevent the development of arthrosis.

EFFECT: higher efficiency of therapy.

1 dwg

FIELD: traumatology and orthopedics.

SUBSTANCE: apparatus for cutting-through of nut-shaped threaded rods with hexagonal base is made paired and comprises inserts and screws. Insert receptacle is provided in base and is open toward one of nut ribs. Insert receptacle is equipped with slot open toward the same side. Threaded-through openings for receiving of headless screws are extending perpendicular to slot axis in nut wall. Headless screws have sharpened ends and are provided with grooves. Inserts are formed as bars of rectangular section. Outer base of each bar is chamfered. Inner base is rounded to conform to shape of receptacle. Semi-cylindrical slots provided in the vicinity of rounded bases are arranged concentrically with respect to said bases. Concentric slots are provided with thread and upon joining of inserts, their inner long faces define threaded opening for receiving of threaded rod after cutting-through of threaded rod. Conical depressions are formed on outer faces of inserts for receiving sharpened ends of headless screws. Contractor is made in the form of pair of pivotally connected intersecting branches with working parts and tie rod. Working parts are arranged at different levels and formed as nut holders made as hollow semi-cylinders generatrix edges of which are formed as straight plates extending beyond diameters of semi-cylinder. Straight plates are contacting with one another with their sliding ends. Inner diameter of semi-cylinders corresponds to space between opposite nut faces. Semi-cylinder bottoms are arranged at opposite sides and provided with slots whose openings face one another. Axes of outer semi-circular slot ends are eccentrically extending to the outside of axes of semi-cylinders. Tie rod is positioned on inoperative ends of branches. Tie rod screw head is pivotally mounted on one of branches. End of said screw extends through recess at end of other branch and is equipped with wing nut. Upon joining of branches, ends of straight plates are brought into contact with and overlap one another.

EFFECT: reduced traumatism during cutting-trough of excessively extending ends of threaded rods of bone retainers, including portions between supports of compression-distraction apparatus.

3 cl, 7 dwg

FIELD: medicine, traumatology, orthopedics, palm surgery.

SUBSTANCE: transarticularly one should fix 2-5 fingers at bending the main phalanges up to the angle of 100° with needles or dowels applied through the bottom of the main phalanges and capita of metacarpal bones to obtain stable fibrous or osseous ankylosis in fixed joints to better restore patient's fingers grasping function.

EFFECT: higher efficiency of restoration.

3 dwg, 1 ex

FIELD: medicine, traumatology, purulent surgery.

SUBSTANCE: after performing fistulosequestrnecrectomy, multiple revascularizing osteoperforations with Kirschner's needle in area of pathological focus one should carry out total cutting trepanation of medullary canal from the side of sequestral cavity with the help of a spheroidal cutting, fulfill linear osseous trepanations in area of proximal and distal metaepiphyses out of two point incisions to combine metaepiphyseal sources of circulation with diaphyseal vascular system and apply the capacities of the nearest muscular area that provides optimal conditions for tissue regeneration.

EFFECT: higher efficiency of therapy.

5 dwg, 1 ex

FIELD: medicine, orthopedics.

SUBSTANCE: in the course of reposition after external rotation, unbending and femoral adduction one should fix epiphyseal position transacetabularly with the needles applied, then femur should be bent, rotated inwards to be abducted to fix the fragments obtained with the bundle of needles. One should remove earlier transacetabularly introduced needles and by achieving a position of femoral normocorrection it is necessary to perform close osteosynthesis of femur and ilium with apparatus for external fixation, moreover, further maintenance of unloading conditions in patent's hip joint should be performed before consolidation of affected segment's fragments that prevents the development of trophic disorders.

EFFECT: higher efficiency of therapy.

1 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.

EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.

5 cl, 1 dwg