摘要
目的介绍一种新型抗钙化异种猪瓣，并对其临床移植后的早期血流动力学进行评价。方法应用环氧氯丙烷（ＥＣ）化学改性戊二醛（ＧＡ）处理猪瓣。对这类改性后生物材料特性、弹性瓣架进行了实验研究，并应用Ｓｗａｎ－Ｇａｎｚ导管技术和二维超声心动图对换瓣病例进行了早期血流动力学观察。结果（１）ＥＣ改性后的猪瓣经移植于新西兰兔皮下２周、４周、６周后比对照组明显减轻钙化２．４～５．０倍；（２）ＥＣ改性后的猪瓣组织稳定性和机械抗张强度与对照组相比无明显差别；（３）游离羧基含量下降６．９倍，抗原性为阴性；（４）自行设计的三柱等距高弹性钢丝瓣架，对瓣叶承受的应力减小至９０％以下；（５）新型生物瓣体外流体力学测试平均跨瓣压差，有效开口面积，瓣口回流百分比以及流场均接近生理状态；（６）临床应用２４只新型生物瓣给２１例患者进行瓣膜移植，随访３月～５年未有瓣膜故障导致不良后果者。结论新型异种猪生物瓣既具有明显抗钙化效果，又保持了良好的组织结构和机械强度，组织相容性好，早期临床血流动力学满意。
Objective To introduce a new type anti calcific heterograft porcine valve and evaluate clinically the early hemodynamic effect after its replacement. Methods The glutaraldehyde(GA) treated porcine aortic valves were modified chemically with epoxy chloropropane (EC). The experimental studies for the feature of the tissue material and its spring frame were performed and the early hemodynamic effect of the valves was examined with Swan Ganz catheter technique and two dimensional echocardiography. Results (1) The excellent anti calcific result was found in the modified valves at 2, 4, 6 weeks after implantation in New Zealand young rabbits. The calcium deposit deseased 2.5-5.0 times compared with the control group. (2) There were good tissue stability and mechanical tensile strength. (3) The content of free carboxyl group in the modified valve decreased 6.9 times and the immunologic reaction in modified valve was negative. (4) The high spring frame was designed and the stress of valve was decreased to less than ninety percent compared with control group. (5) The mean pressure gradient across the valve orifice, the effective valvular orifice and the percentage of regaugitation were near to the physiologic state by hemodynamic investigation in vitro of the new cardiac tissue valve. (6) Twenty four new cardiac tissue valves implanted in 21 patients showed excellent hemodynamic performance in 3 months-5 years postoperatively. Conclusion The new type heterograft porcine valve not only has a excellent anti calcific effect, but also maintains the normal tissue structure and mechanic strength. The early hemodynamic effects are satisfactory clinically. There were no significant complication due to the valve dysfunction.
出处
《中国胸心血管外科临床杂志》
CAS
1997年第3期129-132,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
国家八五攻关课题
