1，手术前病人的准备<ol><li>患者根据标准程序给予全身麻醉。 </li><li>他被放置在仰卧位手术台上。 </li><li>右颈部线条和右心房PICC线被拆除。 </li><li>他接受访问中央在左股静脉和保持与他的动脉线。 </li><li>一个TEE探头放置并表现出严重抑郁症的双心室功能和显著主动脉瓣关闭不全。 </li></ol> 2。Cardiectomy <ol><li>病人被定位，消毒铺巾在正常无菌时尚重复胸骨。 </li><li>重复胸骨完成（ 图4）。立即明显是极其心脏扩大和严重粘连。 </li><li>膈面解剖出来。它被狠狠坚持继发于心外膜导线。病人绝不会容忍的显著变动的心脏在试图到达下腔静脉（IVC）。 </li><li>主动脉解剖。 </li><li>在右股静脉解剖。 </li><li>拨弄钱包的丝带被放置在主动脉和股静脉，肝素给药，和在主动脉和右股静脉插管。静脉插管的尖端推进到下腔静脉。 </li><li>达到适当的活化凝血时间（ACT）后，患者走上体外循环。由于他的全身血管阻力显着，由于严重的心脏衰竭升高，须积极降低后负荷达到足够的灌注压。 </li><li>病人被置于与MPA发泄以达到更好的减压左侧心脏的。然而，很明显与全流，这将是一个艰难的血流动力学电路保持稳定，主要是由于显著主动脉瓣关闭不全。 </li><li>上腔静脉（SVC）的解剖和插管，病人被放置在bicavalÇardiopulmonary旁路（ 图5）。 </li><li>下腔静脉解剖和主动脉呈交叉夹紧。这使心脏的彻底减压。 </li><li>主动脉和主扩声被划分（ 图6）。 </li><li>心室面，包括膈面，左心房排水沟，右心房排水沟的其余部分被解剖出来​​。 MPA的，PA的分支近端的PA分行也解剖。 </li><li>右心室解剖出来，留下大约3-4毫米右房室瓣下肌（ 图7A）。 </li><li>左心室解剖出离开左房室瓣（ 图7B）下心室肌的3-5毫米袖带。 </li></ol> 3，TAH植入<ol><li>在一架MH针采用大普理灵，先前准备的毡条戈尔纺绩品是皮鞭，巩固的心室肌袖口肌肉边缘。 </li><li>心房快速连接被修剪成一个3-4毫米边缘。它被反相并缝到袖肌肉都在左侧和右侧，以防止扇形（ 图8）。 </li><li>心室被隧道出刚刚离开中线和流出移植切成适当的大小。 </li><li>敖和PA袖口采用连续缝合（ 图9）缝制。 </li><li>房车与PA导管和钙化区域被切除。 </li><li>心房袖口均进行泄漏测试，然后将敖和PA吻合进行了测试</li><li>动力传动系统隧道的创建（ 图10）。 </li><li>左TAH心室被连接到左心房袖，然后到主动脉（ 图11）。 </li><li>然后敖的流出移植物连接到系统和横夹中缓慢释放（ 图12a）。 </li><li>在此之后，TAH右心室连接到RA的心房袖，然后到在PA（ 图12b）。 </li><li>在最后的位置上，TAH脑室中以并行方式进行对齐，因为PA接枝未越过主动脉移植物的顶端由于TGA解剖（ 图13）。 </li><li>右心室被去除空气通过去除下腔静脉圈套，一个活跃的根排气口被放置在升奥复温，并已完成。 </li><li>肺部被吸入通风和TAH被打开以取消空气在上升敖活性根排气孔。 </li><li>病人被取下体外循环和TAH的速率增加。 </li><li>取得了良好的血流动力学，并给予鱼精蛋白后，心脏被拔管。 </li><li>一旦止血达到了，四胸管放置：在​​纵隔和后纵隔，一个大40胸管前纵隔，和一个直角胸管在左胸2布雷克。 </li><li>由薄戈尔 - TEX的neopericardium是科瑞ED和周围放置设备。一旦完成，整个纵隔灌溉用温水抗生素生理盐水丰富金额。 </li><li>胸骨被关闭与手术钢丝，同时确保关胸没有造成任何压缩到TAH。皮肤和皮下组织被关闭的图层。 </li><li>在腹股沟获得止血后，该地区被关闭。 </li><li>在AICD口袋的培养，在AICD除去，小漏被放置在口袋中。 </li><li>病人耐受这种非常复杂的过程很好，被转移到CVICU在稳定的血液​​动力学和呼吸状态。该患者拔管术后第2天，不像管理心室辅助装置，术后护理TAH并不需要正性肌力药。流体控制和后负荷降低是术后护理的主要部分。抗凝以每制造商的协议第2天开始。 </li></ol>

<ol>
	<li>Kirsch, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=SynCardia+temporary+total+artificial+heart+as+bridge+to+transplantation:+current+results+at+la+piti&#233;+hospital.">SynCardia temporary total artificial heart as bridge to transplantation: current results at la piti&#233; hospital.</a> Ann Thorac Surg. 95 (5), 1640-1646 (2013).</li><li>Copeland, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Total+artificial+hearts:+bridge+to+transplantation.">Total artificial hearts: bridge to transplantation.</a> Cardiol Clin. 21 (1), 101-113 (2003).</li><li>Roussel, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=CardioWest+(Jarvik)+total+artificial+heart:+a+single-center+experience+with+42+patients.">CardioWest (Jarvik) total artificial heart: a single-center experience with 42 patients.</a> Ann Thorac Surg. 87 (1), 124-129 (2009).</li><li>Slepian, M., Alemu, Y., Soares, J., Smith, R., Einav, S., Bluestein, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Syncardia+total+artificial+heart:+in+vivo,+in+vitro,+and+computational+modeling+studies.">The Syncardia total artificial heart: in vivo, in vitro, and computational modeling studies.</a> J Biomech. 46 (2), 266-275 (1016).</li><li>Koyak, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sudden+cardiac+death+in+adult+congenital+heart+disease.">Sudden cardiac death in adult congenital heart disease.</a> Circulation. 126 (16), 1944-1954 (2012).</li><li>Shaddy, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Applying+heart+failure+guidelines+to+adult+congenital+heart+disease+patients.">Applying heart failure guidelines to adult congenital heart disease patients.</a> Expert Rev Cardiovasc Ther. 6 (2), 165-174 (2008).</li><li>Warnes, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transposition+of+the+great+arteries.">Transposition of the great arteries.</a> Circulation. 114, 2699-2709 (2006).</li><li>Rutledge, J., Nihill, M., Fraser, C., Smith, O., McMahon, C., Bezold, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcome+of+121+patients+with+congenitally+corrected+transposition+of+the+great+arteries.">Outcome of 121 patients with congenitally corrected transposition of the great arteries.</a> Pediatr Cardiol. 23, 137-145 (2002).</li><li>Graham, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+outcome+in+congenitally+corrected+transposition+of+the+great+arteries:+a+multi-institutional+study.">Long-term outcome in congenitally corrected transposition of the great arteries: a multi-institutional study.</a> J Am Coll Cardiol. 36, 255-261 (2000).</li><li>Voskuil, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Postsurgical+course+of+patients+with+congenitally+corrected+transposition+of+the+great+arteries.">Postsurgical course of patients with congenitally corrected transposition of the great arteries.</a> Am J Cardiol. 83, 558-562 (1999).</li><li>Hoffman, J., Kaplan, S., Liberthson, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+congenital+heart+disease.">Prevalence of congenital heart disease.</a> Am Heart J. 147 (3), 425-439 (2004).</li><li>Marelli, A., Mackie, A., Ionescu-Ittu, R., Rahme, E., Pilote, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Congenital+Heart+Disease+in+the+General+Population:+Changing+Prevalence+and+Age+Distribution.">Congenital Heart Disease in the General Population: Changing Prevalence and Age Distribution.</a> Circulation. 115, 163-172 (2007).</li><li>DiNardo, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Heart+failure+associated+with+adult+congenital+heart+disease.">Heart failure associated with adult congenital heart disease.</a> Semin Cardiothorac Vasc Anesth. 17, 44-54 (2013).</li></ol>

生产这种视频文章的赞助，SynCardia。

腹式被设计为桥梁，以心脏移植患者的正常结构的心。它使患者恢复健康和体力，因为他们等待捐赠心脏。此前，患者畸形的心并没有考虑考生用于接收TAH由于本不同寻常的解剖结构所带来的挑战。本文着重介绍了台安与修改，是一个可行的选择，患者CCTGA，先天条件设有L-环脑室和在通常的心房安排设置调换大动脉。植入TAH与CCTGA患者需要一个技术修饰，以植入在平行取向，而不是典型的交叉设置的左，右泵。 该报告还表明，TAH可以提供比在危重患者复杂病变心脏心室辅助装置的放置一个简单的解决方案。在这种情况下，患者患有严重的AI和肥胖结构探讨LV和PA之间的管道。该TAH被认为比的支持与VAD方案，这将需要多个伴随外科手术是更好的选择。在这种情况下，报告中的患者可以回家，恢复健康和力量前五个月接到TAH后被成功过渡到心脏移植。 随着医疗和手术治疗，提高患者的冠心病号码进步生存到成年11,12。成人患有严重冠心病的患病率1985年和2000年第12间增加85％。成人冠心病现有人口租税孩子有冠心病，这成人人口的显著子集有13 HF的风险增加。这表现在这种情况下，TAH为冠心病患者与HF的附加选项。在越来越多的成年患者的心衰是由于先天性心脏疾病的光，这种情况下应该代表对于那些畸形的心机械辅助循环的新时代的开始。

全人工心脏（TAH）被开发为桥梁，以患者的心脏衰竭（HF）1-4心脏移植。该设备是一种机械循环支持系统，它取代了心室，与延长寿命，直到一个合适的捐赠心脏变为可用的目的。先天性心脏疾病有时会导致高频，与需要循环支持5,6例。与CCTGA个人，主动脉和肺动脉（PA）的转置和心室被反转7。这种情形可能最终导致HF由于形态学右心室（RV）的无力抵抗泵全身血管阻力8-10。 在这里呈现的情况下，该患者接受了多个童年手术为他CCTGA，包括RASTELLI维修和随后的静脉双腔起搏器系统。作为一个少年，他开发的HF的症状，由于功能障碍全身的房车。他的病情很复杂严重主动脉瓣关闭不全（AI）和阻塞导管置于左心室（LV）与PA之间的存在。经过多次住院治疗，包括位置与植入式心律转复除颤器（ICD），他提前到终末期HF和进入肾功能衰竭及心源性休克，需要插管和循环支持。 虽然TAH设计为与通常结构的心个人，该装置被认为是对生存考虑他的病情的严重性和复杂的心脏损伤的存在患者的最佳选择。为了适应他的换位动脉和倒脑室中，台安被植入过程中修改，而且手术是成功的。植入三个月后，他出院回家。他植入与TAH后5个月收到的捐赠心脏。 病例报告： &lt;P类=“jove_content”&gt;患者是一名17岁的白人男性CCTGA，肺动脉闭锁的历史，室间隔缺损（VSD）（ 图1A和1B）。他有一个升主动脉至肺动脉分流术和心外膜起搏器放置在婴儿期。 4岁时，他接受了古典（RASTELLI）维修，包括室间隔缺损闭合一个LV的形态与PA导管和安置。残差VSD关闭与应用Amplatzer封堵器在11岁时，他随后接受了双腔静脉起搏系统。在16岁时，他正与心脏再同步化治疗（CRT）治疗。 在17岁的病人出现了急诊室（ER）与呼吸困难后违规用药数天。他报告说，前ER访问四天胸痛短暂的插曲。该患者用利尿剂处理过夜，并用药物重新建立出院回家。在他的HOSPItalization，心脏移植，详细与患者及其家属进行了讨论。一个完整的移植评估进行和患者随后上市。 九个月后，他被送往医院晕厥与房颤相关的一个小插曲之后。他接受了直流（DC）电复律。出院四天后，他回到了急诊室有胸痛和咯血投诉。他随后返回两天后，报告增加胸痛。电脑断层扫描（CT）显示在右下肺叶分布肺栓塞，以及作为一个单独的浸润。抗凝治疗开始。两个星期后，植入式心脏复律除颤器（ICD）置于经过一段时间的非持续性室性心动过速。 病人出院ICD安置九天后返回，但四天后抱怨的反复发作呼吸困难及心悸，晚上平躺时，以及慢性恶心和食欲下降。他再次承认在这个时候。他进入的药物，每日每日每日两次，地高辛125微克口服，氢氯噻嗪25毫克口服，每日的华法林5.5 mg，口服，依那普利10毫克口服，每日两次，速尿40毫克口服，每日两次，而美托洛尔50 mg，口服。他服用枢复宁，科拉切，Miralax和泰诺在需要的基础。他没有已知的药物过敏。 心血管检查是弥漫性点最大冲动显著。在听诊，有一个单一的S1定期的节奏和固定，分裂S2。有一个IV级/六，至/来回，收缩期/舒张期杂音在胸骨左缘。要害是心脏率94，血压五十四分之九十八。肺是为减少呼吸显著的声音在正确的基础。胸部X线显示严重的心脏扩大与严重拥堵肺野。有一个小的右侧胸腔积液<s>。</s>血液检查是渐进性低钠血症，增加了法国，并在他的尿素氮轻度增加显著。病人被指出有严重抑郁双心室收缩功能，并且至少中等导管阻塞。 病人的HF继续在以下几个星期的进步，具有多种承认了重症监护室。下面晕厥心律失常发作后，他考入并放置在米力农。他仍然米力农依赖于医院，但仍然有进步的HF症状。在48小时的时间内，他进入严重心衰合并肾功能衰竭和需要插管。 24小时内插管，心脏功能不全的进展，与恶化灌注。他停止生产尿，他的肌酐开始上升，他也就降血压。 诊断，评估和计划： 该患者被诊断出患有严重心衰和心源性休克第二进制到CCTGA，状态后经典修复。二次诊断包括形态学左室流出道阻塞和VSD。尽管他的先天畸形的心脏带来的挑战，紧急TAH植入术被认为是给他的病​​情危重，复杂心脏粘连为生存而他最好的机会。通过腹股沟或临时心室放置体外膜肺氧合（ECMO）的替代解决方案，通过在胸部或腹股沟辅助装置（VAD）被排除，因为他的严厉AI和左室流出道阻塞。有人认为，停止心脏，并试图把一个VAD，同时也改变了LV与PA导管及主动脉瓣，不会是一个可行的选择以及患者很可能需要一个双心室辅助装置（BiVAD）。多巴胺加入到米力农之前的手术稳定患者的血压。 手术方案包括TAH的修改，使得左，右泵是我mplanted在平行取向，而不是正常纵横交错排列（ 图2A，2B和2C）。这种不寻常的方向的主要决定因素是L-环心室（一形态学左心室右侧，反之亦然），并转大动脉，与主动脉前壁和向左肺动脉（ 图3A和3B）。

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			<td height="21" style="height:21px;width:167px;">Alumina abrasive film</td>
			<td style="width:128px;">Thomas Scientific</td>
			<td style="width:91px;">#6775E-38</td>
			<td style="width:331px;">Course (12 &#181;m), for major repairs of forceps tips</td>
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			<td height="42" style="height:42px;width:167px;">Alumina abrasive film</td>
			<td style="width:128px;">Thomas Scientific</td>
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			<td style="width:331px;">Medium (3 &#181;m), for fine sharpening of forceps tips</td>
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			<td height="21" style="height:21px;width:167px;">Alumina abrasive film</td>
			<td style="width:128px;">Thomas Scientific</td>
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			<td style="width:331px;">Fine (0.3 &#181;m), for polishing of forceps tips</td>
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			<td height="63" style="height:63px;width:167px;">Forceps: Dumont, Dumoxel Biologie #5</td>
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			<td style="width:331px;">These have the fine tips that do not need sharpening when first purchased. Corrosive resistant so they can be autoclaved.</td>
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			<td height="21" style="height:21px;width:167px;">Gentamicin solution</td>
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</table>

implantation of total artificial heart in congenital heart disease

患者的终末期心脏衰竭（HF），一个全人工心脏（TAH）可植入的桥梁，心脏移植。然而，在先天性心脏疾病（CHD），畸形心脏提出了挑战TAH植入。 在这里介绍的情况下，一名17岁的患者大血管（CCTGA）先天性转位经验丰富的逐步恶化的HF由于他的先天条件。他住院多次，并获得了植入式心律转复除颤器（ICD）。然而，他的病情很快恶化，终末期HF与多系统器官功能衰竭。 由于病人的严重临床情况和复杂的心脏损伤的存在，这项决定是继续与TAH。在植入过程中患者的心室和大血管的异常安排必要的修改，以腹式。 随着地方TAH，患者可以回家，恢复力量和身体安康，而等待捐赠心脏。他5个月接收设备后成功过渡到心脏移植。这份报告突出了TAH是可行的，即使在患者结构异常的心，与技术改造。

该患者的耐受性TAH程序以及三个月后，他被用便携式驱动出院回家。定期TAH门诊协议在这段时间之后，包括物理治疗，职业治疗。 出院后六个星期，他被录取后，高血压危象引起他的司机的功能不佳，导致心输出量减少。他被录取，急诊插管并切换到蓝色巨人的驱动程序，从而重新建立了从TAH输出不错。他的病情好转了几天的课程。他被华法林上重新建立在等待一个新的便携式驱动程序时，合适的供体心脏变得可用，患者被送往移植。血浆置换（净零，使用4.2升的FFP）是对供体心脏进行，以明确的供体特异性抗体。 在手术过程中，患者被发现有严重粘连。主动脉移植物是坚持以胸骨后和致密粘连包围TAH。有感染的迹象。下腔静脉（IVC）是很难找到，因为TAH的右心室前壁定位到下腔静脉。因为CCTGA时，功率放大器进行解剖，以提供全面的移动性和大血管，然后连接在正确的方向。由于心脏，尤其是左心房的取向异常，下腔静脉的外侧是稍长离开了。手术复杂，从口咽，这之前，采取病人关闭旁路必要耳鼻喉科评估和地区的包装一个显著出血。左心房线放在通过左心房吻合脱落体外循环前。一旦断奶搭桥，心脏功能还是挺不错的。心外膜超声心动图显示，所有阀门均运作良好，以及两个心室的功能。鱼精蛋白被赋予。无微不至的关怀被带到达到止血。该患者的耐受性良好的程序，并转移到稳定的血液​​动力学和呼吸状态的心血管重症监护病房。 <img alt="图1" fo:content-width="5in" src="/files/ftp_upload/51569/51569fig1.jpg" /> 图1。先天性矫正性大动脉转位。病人的CT扫描，与冠状面（A）和轴向图（b）显示与L-环心室（右侧，反之亦然一个形态学左心室）CCTGA和转大动脉，与主动脉前壁和向左到肺动脉。导管放置在形态学左心室与肺动脉之间。 <img alt="图2" fo:content-width="5in" src="/files/ftp_upload/51569/51569fig2.jpg" /> 图2。TAH修改。TAH定位在一个正常成人心脏，用泵对齐在交叉排列（A）和改性方向与CCTGA（B）一个心脏。由于大血管的异常取向，泵需要在平行取向，如在CT（C）所示。 <img alt="图3" fo:content-width="5in" src="/files/ftp_upload/51569/51569fig3.jpg" /> 图3。CCTGA解剖大血管和心室（ 一），正常的安排，并在CCTGA（B）的解剖异常，与敖和PA换位和心室反转。 <img alt="图4" fo:content-width="5in" src="/files/ftp_upload/51569/51569fig4.jpg" /> 图4。正中。TAH植入过程开始的第五次重复胸骨正中。 <img alt="图5" fo:content-width="5in" src="/files/ftp_upload/51569/51569fig5.jpg" /> 图5。Cannul，然后把血管插管和病人放在bicaval体外循环。 <img alt="图6" fo:content-width="5in" src="/files/ftp_upload/51569/51569fig6.jpg" /> 图6。司主动脉和主肺动脉，主动脉被钳位到心脏停止跳动，开始cardiectomy之前。主动脉和肺动脉主干主动脉阻断之后被划分。 <img alt="图7" fo:content-width="5in" src="/files/ftp_upload/51569/51569fig7.jpg" /> 图7。心室切除。心室切除（A），使下面的左，右房室瓣（B）的心室肌的3-5毫米袖带。 <img alt="图8" fo:content-width="5in" src="/files/ftp_upload/51569/51569fig8.jpg" /> 图8。心房袖口缝合后关闭冠状静脉窦和左心耳，防止血栓形成，心房袖口被修整，并用连续缝合仔细缝合。 <img alt="图9" fo:content-width="5in" src="/files/ftp_upload/51569/51569fig9.jpg" /> 移植流出图9。吻合。连续缝合来吻合流出移植到敖和PA。 <img alt="图10" fo:content-width="5in" src="/files/ftp_upload/51569/51569fig10.jpg" /> 图10。完成吻合移植流出的 TAH心室被带入现场。该动力传动系统是通过皮肤。 <img alt="图11" fo:content-width="5in" src="/files/ftp_upload/51569/51569fig11.jpg" /> 图11。附件传动系统隧道。与左侧开始，TAH被连接到心房袖，然后到主动脉。 <img alt="图12" fo:内容宽度=“5英寸”SRC =“/ files/ftp_upload/51569/51569fig12.jpg”/&gt; 十字钳的图12。推出后左TAH心室被连接到左心房袖和主动脉，流出移植物连接到系统和横夹中缓慢释放出来。 <img alt="图13" fo:content-width="5in" src="/files/ftp_upload/51569/51569fig13.jpg" /> 图13。最终TAH位置，TAH泵以平行的方式被定向，以适应TGA解剖结构。

Watch this Scientific Journal Video about Implantation of Total Artificial Heart in Congenital Heart Disease at JoVE.com

Implantation of Total Artificial Heart in Congenital Heart Disease

这与大血管（CCTGA）谁收到了全人工心脏（TAH）为桥梁，以心脏移植的先天纠正换位病人的病例报告。该TAH被成功植入的修改，以适应患者的先天性心脏畸形。

的全人工心脏的先天性心脏病植入

In patients with end-stage heart failure (HF), a total artificial heart (TAH) may be implanted as a bridge to cardiac transplant. However, in congenital ...

implantation-of-total-artificial-heart-in-congenital-heart-disease

Research

JoVE Journal

Medicine

24.3K 次观看.  Texas Children's Hospital. 这与大血管（CCTGA）谁收到了全人工心脏（TAH）为桥梁，以心脏移植的先天纠正换位病人的病例报告。该TAH被成功植入的修改，以适应患者的先天性心脏畸形。 

视频: Implantation of Total Artificial Heart in Congenital Heart Disease

Implantation of a Carotid Cuff for Triggering Shear-stress Induced Atherosclerosis in Mice

It is widely accepted that alterations in vascular shear stress trigger the expression of inflammatory genes in endothelial cells and thereby induce atherosclerosis (reviewed in 1 and 2). The role of shear stress has been extensively studied in vitro investigating the influence of flow dynamics on cultured endothelial cells 1,3,4 and in vivo in larger animals and humans 1,5,6,7,8. However, highly reproducible small animal models allowing systematic investigation of the influence of shear stress on plaque development are rare. Recently, Nam et al. 9 introduced a mouse model in which the ligation of branches of the carotid artery creates a region of low and oscillatory flow. Although this model causes endothelial dysfunction and rapid formation of atherosclerotic lesions in hyperlipidemic mice, it cannot be excluded that the observed inflammatory response is, at least in part, a consequence of endothelial and/or vessel damage due to ligation.
In order to avoid such limitations, a shear stress modifying cuff has been developed based upon calculated fluid dynamics, whose cone shaped inner lumen was selected to create defined regions of low, high and oscillatory shear stress within the common carotid artery 10. By applying this model in Apolipoprotein E (ApoE) knockout mice fed a high cholesterol western type diet, vascular lesions develop upstream and downstream from the cuff. Their phenotype is correlated with the regional flow dynamics 11 as confirmed by in vivo Magnetic Resonance Imaging (MRI) 12: Low and laminar shear stress upstream of the cuff causes the formation of extensive plaques of a more vulnerable phenotype, whereas oscillatory shear stress downstream of the cuff induces stable atherosclerotic lesions 11. In those regions of high shear stress and high laminar flow within the cuff, typically no atherosclerotic plaques are observed.
 
In conclusion, the shear stress-modifying cuff procedure is a reliable surgical approach to produce phenotypically different atherosclerotic lesions in ApoE-deficient mice.

The constricting cuff presented in this article is designed to induce atherosclerosis in the murine common carotid artery. Due to the conical shape of its inner lumen the implanted cuff generates well-defined regions of low, high and oscillatory shear stress triggering the development of atherosclerotic lesions of different inflammatory phenotypes.

植入小鼠触发剪应力致动脉粥样硬化的颈袖

It is widely accepted that alterations in vascular shear stress trigger the expression of inflammatory genes in endothelial cells and thereby induce ...

科研

医学

A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and  Ease of Implantation

Implantable cardioverter-defibrillators (ICDs) terminate ventricular tachycardia (VT) and ventricular fibrillation (VF) with high efficacy and can protect patients from sudden cardiac death (SCD). However, inappropriate shocks may occur if tachycardias are misdiagnosed. Inappropriate shocks are harmful and impair patient quality of life. The risk of inappropriate therapy increases with lower detection rates programmed in the ICD. Single-chamber detection poses greater risks for misdiagnosis when compared with dual-chamber devices that have the benefit of additional atrial information. However, using a dual-chamber device merely for the sake of detection is generally not accepted, since the risks associated with the second electrode may outweigh the benefits of detection. Therefore, BIOTRONIK developed a ventricular lead called the LinoxSMART S DX, which allows for the detection of atrial signals from two electrodes positioned at the atrial part of the ventricular electrode. This device contains two ring electrodes; one that contacts the atrial wall at the junction of the superior vena cava (SVC) and one positioned at the free floating part of the electrode in the atrium. The excellent signal quality can only be achieved by a special filter setting in the ICD (Lumax 540 and 740 VR-T DX, BIOTRONIK). Here, the ease of implantation of the system will be demonstrated.

Dual-chamber implantable cardioverter-defibrillators (ICDs) may improve detection of atrial fibrillation as well as differentiation of tachycardias. However, this advantage is undermined by complications associated with the second electrode, which is required in conventional dual chamber devices. Therefore, BIOTRONIK has developed a new electrode called the LinoxSMART S DX that, when used in conjunction with the Lumax DX ICD, offers dual-chamber detection without the risks associated with the second electrode.

心房遥感新的单一商会植入去纤颤器：一个实用的遥感示范和易于植入

Implantable cardioverter-defibrillators (ICDs) terminate ventricular tachycardia (VT) and ventricular fibrillation (VF) with high efficacy and can protect ...

Implantation of the Syncardia Total Artificial Heart

With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of such patients are generally well served by left ventricular assist devices (LVADs). However, a subset of patients with late stage biventricular failure or other significant anatomic lesions are not adequately treated by isolated left ventricular mechanical support. Examples of concomitant cardiac pathology that may be better treated by resection and TAH replacement includes: post infarction ventricular septal defect,&#160;aortic root aneurysm / dissection, cardiac allograft failure, massive ventricular thrombus, refractory malignant arrhythmias (independent of filling pressures), hypertrophic / restrictive cardiomyopathy, and complex congenital heart disease. Patients often present with cardiogenic shock and multi system organ dysfunction. Excision of both ventricles and orthotopic replacement with a total artificial heart (TAH) is an effective, albeit extreme, therapy for rapid restoration of blood flow and resuscitation. Perioperative management is focused on end organ resuscitation and physical rehabilitation. In addition to the usual concerns of infection, bleeding, and thromboembolism common to all mechanically supported patients, TAH patients face unique risks with regard to renal failure and anemia. Supplementation of the abrupt decrease in brain natriuretic peptide following ventriculectomy appears to have protective renal effects. Anemia following TAH implantation can be profound and persistent. Nonetheless, the anemia is generally well tolerated and transfusion are limited to avoid HLA sensitization. Until recently, TAH patients were confined as inpatients tethered to a 500 lb pneumatic console driver. Recent introduction of a backpack sized portable driver (currently under clinical trial) has enabled patients to be discharged home and even return to work. Despite the profound presentation of these sick patients, there is a 79-87% success in bridge to transplantation.

The purpose of this manuscript is to briefly review indications, management, and outcomes for the total artificial heart. Video operative techniques for device implantation are presented.

SynCardia全人工心脏植入术

With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of ...

Assessment of Cardiac Function and Myocardial Morphology Using Small Animal Look-locker Inversion Recovery (SALLI) MRI in Rats

Small animal magnetic resonance imaging is an important tool to study cardiac function and changes in myocardial tissue. The high heart rates of small animals (200 to 600 beats/min) have previously limited the role of CMR imaging. Small animal Look-Locker inversion recovery (SALLI) is a T1 mapping sequence for small animals to overcome this problem 1. T1 maps provide quantitative information about tissue alterations and contrast agent kinetics. It is also possible to detect diffuse myocardial processes such as interstitial fibrosis or edema 1-6. Furthermore, from a single set of image data, it is possible to examine heart function and myocardial scarring by generating cine and inversion recovery-prepared late gadolinium enhancement-type MR images 1.
	The presented video shows step-by-step the procedures to perform small animal CMR imaging. Here it is presented with a healthy Sprague-Dawley rat, however naturally it can be extended to different cardiac small animal models.

Assessment of Cardiac Function and Myocardial Morphology Using Small Animal Look-locker Inversion Recovery SALLI MRI in Rats

Contrast enhanced cardiac magnetic resonance (CMR) imaging allows comprehensive in vivo assessment of the heart in small animal models of cardiovascular disease. Here we detail the procedures to perform CMR imaging, reconstruction and analysis using Small Animal Lock-Locker Inversion Recovery (SALLI) in rats.

使用小动物看更衣室反转恢复（SALLI）的MRI大鼠心脏功能和心肌形态学评估

Small animal magnetic resonance  imaging is an important tool to study cardiac function and changes in myocardial  tissue. The high heart rates of small ...

Echocardiographic Approaches and Protocols for Comprehensive Phenotypic Characterization of Valvular Heart Disease in Mice

The aim of this manuscript and accompanying video is to provide an overview of the methods and approaches used for imaging heart valve function in rodents, with detailed descriptions of the appropriate methods for anesthesia, the echocardiographic windows used, the imaging planes and probe orientations for image acquisition, the methods for data analysis, and the limitations of emerging technologies for the evaluation of cardiac and valvular function. Importantly, we also highlight several future areas of research in cardiac and heart valve imaging that may be leveraged to gain insights into the pathogenesis of valve disease in preclinical animal models. We propose that using a systematic approach to evaluating cardiac and heart valve function in mice can result in more robust and reproducible data, as well as facilitate the discovery of previously underappreciated phenotypes in genetically-altered and/or physiologically-stressed mice.

This protocol provides a detailed description of the echocardiographic approach for comprehensive phenotyping of heart and heart valve function in mice.

超声心动图方法和协议心脏瓣膜疾病的综合表型特征小鼠

The aim of this manuscript and accompanying video is to provide an overview of the methods and approaches used for imaging heart valve function in ...

Shunt Surgery, Right Heart Catheterization, and Vascular Morphometry in a Rat Model for Flow-induced Pulmonary Arterial Hypertension

In this protocol, PAH is induced by combining a 60 mg/kg monocrotalin (MCT) injection with increased pulmonary blood flow through an aorto-caval shunt (MCT+Flow). The shunt is created by inserting an 18-G needle from the abdominal aorta into the adjacent caval vein. Increased pulmonary flow has been demonstrated as an essential trigger for a severe form of PAH with distinct phases of disease progression, characterized by early medial hypertrophy followed by neointimal lesions and the progressive occlusion of the small pulmonary vessels. To measure the right heart and pulmonary hemodynamics in this model, right heart catheterization is performed by inserting a rigid cannula containing a flexible ball-tip catheter via the right jugular vein into the right ventricle. The catheter is then advanced into the main and the more distal pulmonary arteries. The histopathology of the pulmonary vasculature is assessed qualitatively, by scoring the pre- and intra-acinar vessels on the degree of muscularization and the presence of a neointima, and quantitatively, by measuring the wall thickness, the wall-lumen ratios, and the occlusion score.

This protocol describes a surgical procedure to create a model for flow-induced pulmonary arterial hypertension (PAH) in rats and the procedures to analyze the principle hemodynamic and histological end-points in this model.

分流手术，右心导管，血管形态计量学在大鼠模型中的流量引起的肺动脉高压

In this protocol, PAH is induced by combining a 60 mg/kg monocrotalin (MCT) injection with increased pulmonary blood flow through an aorto-caval shunt ...

Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart

Mechanical circulatory support (MCS) has been introduced as a viable alternative to heart transplantation primarily through the use of intracorporeal ventricular assist devices (VADs) for support of the left ventricle. However, certain clinical scenarios warrant biventricular mechanical support. One strategy for some patients is the excision of both ventricles and the implantation of two VAD pumps as a total artificial heart (TAH). This has recently been made possible by the improvements in device design and the small profile of centrifugal devices. This TAH approach remains experimental with many important challenges such as the device settings to balance the right and left circulation, the orientation of the devices and the outflow graft with their influence on hemolysis and stability, and the outcome of chronic support using such an orientation. This protocol aims to provide a reproducible approach for total artificial heart replacement with two intracorporeal centrifugal VADs in a cow model.

Here, we present a protocol using two centrifugal pumps as a total artificial heart replacement.

两体内心室辅助装置作为全人工心脏的应用

Mechanical circulatory support (MCS) has been introduced as a viable alternative to heart transplantation primarily through the use of intracorporeal ...

Implantation of hiPSC-derived Cardiac-muscle Patches after Myocardial Injury in a Guinea Pig Model

Due to the limited regeneration capacity of the heart in adult mammals, myocardial infarction results in an irreversible loss of cardiomyocytes. This loss of relevant amounts of heart muscle mass can lead to the heart failure. Besides heart transplantation, there is no curative treatment option for the end-stage heart failure. In times of organ donor shortage, organ independent treatment modalities are needed. Left-ventricular assist devices are a promising therapy option, however, especially as destination therapy, limited by its side-effects like stroke, infections and bleedings. In recent years, several cardiac repair strategies including stem cell injection, cardiac progenitors or myocardial tissue engineering have been investigated. Recent improvements in cell biology allow for the differentiation of large amounts of cardiomyocytes derived from human induced pluripotent stem cells (iPSC). One of the cardiac repair strategies currently under evaluation is to transplant artificial heart tissue. Engineered heart tissue (EHT) is a three-dimensional in vitro created cardiomyocyte network, with functional properties of native heart tissue. We have created EHT-patches from hiPSC derived cardiomyocytes. Here we present a protocol for the induction of left ventricular myocardial cryoinjury in a guinea pig, followed by implantation of hiPSC derived EHT on the left ventricular wall.

Here we present a protocol for the induction of left ventricular cryoinjury followed by the implantation of a cardiac muscle patch, derived from human iPS-cell cardiomyocytes in a guinea pig model.

几内亚猪模型心肌损伤后 hiPSC-derived 衍生心肌贴片的植入

Due to the limited regeneration capacity of the heart in adult mammals, myocardial infarction results in an irreversible loss of cardiomyocytes. This loss ...

Implantation of an Isoproterenol Mini-Pump to Induce Heart Failure in Mice

Isoproterenol (ISO), is a non-selective beta-adrenergic agonist, that is used widely to induce cardiac injury in mice. While the acute model mimics stress-induced cardiomyopathy, the chronic model, administered through an osmotic pump, mimics advanced heart failure in humans. The purpose of the described protocol is to create the chronic ISO-induced heart failure model in mice using an implanted mini-pump. This protocol has been used to induce heart failure in 100+ strains of inbred mice. Techniques on surgical pump implantation are described in detail and may be relevant to anyone interested in creating a heart failure model in mice. In addition, the weekly cardiac remodeling changes based on echocardiographic parameters for each strain and expected time to model development are presented. In summary, the method is simple and reproducible. Continuous ISO administered via the implanted mini-pump over 3 to 4 weeks is sufficient to induce cardiac remodeling. Finally, the success for ISO model creation may be assessed in vivo by serial echocardiography demonstrating hypertrophy, ventricular dilation, and dysfunction.

The chronic administration of isoproterenol via an implanted osmotic pump has been used widely to mimic advanced heart failure in mice. Here, we describe detailed methods in surgical mini-pump implantation for the continuous isoproterenol administration over 3 weeks, as well as, echocardiographic assessment for the successful model creation.

植入异丙酮醇微型泵，以诱导小鼠心力衰竭

Isoproterenol (ISO), is a non-selective beta-adrenergic agonist, that is used widely to induce cardiac injury in mice. While the acute model mimics ...

Novel Percutaneous Approach for Deployment of 3D Printed Coronary Stenosis Implants in Swine Models of Ischemic Heart Disease

Minimally invasive methods for creating models of focal coronary narrowing in large animals are challenging. Rapid prototyping using three-dimensionally (3D) printed coronary implants can be employed to percutaneously create a focal coronary stenosis. However, reliable delivery of the implants can be difficult without the use of ancillary equipment. We describe the use of a mother-and-child coronary guide catheter for stabilization of the implant and for effective delivery of the 3D printed implant to any desired location along the length of the coronary vessel. The focal coronary narrowing was confirmed under coronary cineangiography and the functional significance of the coronary stenosis was assessed using gadolinium-enhanced first-pass cardiac perfusion MRI. We showed that reliable delivery of 3D printed coronary implants in swine models (n = 11) of ischemic heart disease can be achieved through repurposing mother-and-child coronary guide catheters. Our technique simplifies the percutaneous delivery of coronary implants to create closed-chest swine models of focal coronary artery stenosis and can be performed expeditiously, with a low procedural failure rate.

We describe a novel, cost-effective, and efficient technique for percutaneous delivery of three-dimensionally printed coronary implants to create closed-chest swine models of ischemic heart disease. The implants were fixed in place using a mother-and-child extension catheter with high success rate.

在缺血性心脏病的猪模型中部署3D打印冠状动脉狭窄植入物的新颖的皮下方法

Minimally invasive methods for creating models of focal coronary narrowing in large animals are challenging. Rapid prototyping using three-dimensionally ...