CN119950967A - Transapical right ventricular balloon catheter - Google Patents
Transapical right ventricular balloon catheter Download PDFInfo
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- CN119950967A CN119950967A CN202411053705.XA CN202411053705A CN119950967A CN 119950967 A CN119950967 A CN 119950967A CN 202411053705 A CN202411053705 A CN 202411053705A CN 119950967 A CN119950967 A CN 119950967A
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Abstract
本发明提供经心尖右心室球囊导管，包括经心尖置入导管，头端设置肺动脉测压口，肺动脉测压口后方设置右室内囊，在右室内囊前方毗邻设置右室测压口；经心尖右心室部置入右心室，经过右心室流出道和肺动脉瓣进入肺动脉；使用时右室内囊和右室测压口位于右心室内，肺动脉测压口位于肺动脉内，在VA‑ECMO辅助前提下，通过对右室内囊注入液体对右心室内腔造成占位，调节右心室输出量，降低肺动脉血流量及肺动脉压；本发明配合VA‑ECMO有效调节心脏功能，在肺移植手术中应用，减少原发性移植肺功能丧失(PGD)发生率，为左心室萎缩患者争取逐渐恢复时间，提高左心萎缩肺移植患者生存率。
The present invention provides a transapical right ventricular balloon catheter, comprising a transapical insertion catheter, a pulmonary artery pressure measuring port arranged at the head end, a right ventricular intraventricular balloon arranged behind the pulmonary artery pressure measuring port, and a right ventricular intraventricular balloon arranged adjacent to the front of the right ventricular balloon; the catheter is inserted into the right ventricle through the apical right ventricular portion and enters the pulmonary artery through the right ventricular outflow tract and the pulmonary valve; when in use, the right ventricular balloon and the right ventricular pressure measuring port are located in the right ventricle, and the pulmonary artery pressure measuring port is located in the pulmonary artery; under the premise of VA-ECMO assistance, liquid is injected into the right ventricular balloon to occupy the right ventricular cavity, thereby regulating the right ventricular output, and reducing the pulmonary artery blood flow and pulmonary artery pressure; the present invention cooperates with VA-ECMO to effectively regulate heart function, is applied in lung transplantation surgery, reduces the incidence of primary transplant lung function loss (PGD), strives for gradual recovery time for patients with left ventricular atrophy, and improves the survival rate of patients with left ventricular atrophy who undergo lung transplantation.
Description
Technical Field
The invention relates to the field of medical instruments, in particular to a transapical right ventricular balloon catheter.
Background
Lung transplantation is the only effective treatment for patients with end-stage lung disease, and the first side transplanted lung is extremely prone to PGD, with incidence rates of up to about 40%. The reason is that, during the period when the first side lung transplantation ends and the second side pulmonary artery is blocked, all the menstrual blood flows all flow through the first side pulmonary blood supply vessels which are just transplanted and opened, so that great capacity burden is caused to the first side pulmonary supply, and simultaneously, the first side pulmonary supply resumes blood supply in the state of just ending ischemia and is in face of ischemia reperfusion injury. Under double hit, the first side supplies the alveolar microvasculature where the moisture, plasma, and even blood cells are very vulnerable to damage to leak into the alveoli, resulting in pulmonary edema, leading to the occurrence of primary graft pulmonary dysfunction (PGD).
Once PGD occurs, transplanted lung function resumes very slowly. Pulmonary water enters the other lung alveoli, and the incidence of infection increases significantly, often taking 1-2 weeks to recover gradually and even die.
There is a critical need in the clinic for a medical product that can be used in combination with VA-ECMO to substantially reduce first side pulmonary blood flow, reduce pulmonary arterial pressure, and reduce the incidence of PGD during single-sided pulmonary ventilation.
At the same time, pulmonary arterial pressure significantly increases in lung transplant patients, with severe right ventricular hypertrophy and left ventricular disuse atrophy. After the double-lung transplantation is completed, the pulmonary blood vessels are unobstructed, the hypertrophic right ventricle pumps out full blood flow into the pulmonary blood vessels to enter the left ventricle, the atrophic left heart is difficult to bear the rising preload, and the left heart failure and pulmonary edema are often caused to occur, and even if VA-ECMO is used for assistance, the effect is very limited by using the aortic counterpulsation saccule.
After the lung transplantation, the patients need a medical product urgently, and the VA-ECMO is matched with the medical product to fully reduce the output of the right ventricle, avoid the left heart failure and enable the left ventricle function to gradually recover to the normal state after exercising.
Disclosure of Invention
In view of the above-described deficiencies of the prior art, the present invention provides a transapical right ventricular balloon catheter, including a transapical deployment catheter.
The head end of the transapical catheter is provided with a pulmonary artery pressure measuring port, the transapical catheter is internally provided with a pulmonary artery pressure measuring cavity, and the tail end of the pulmonary artery pressure measuring cavity is communicated with a pulmonary artery pressure measuring pipe through the transapical catheter.
The right chamber bag is arranged around the rear of the pulmonary artery pressure measuring port through the apex implantation catheter, a right chamber bag filling cavity is arranged in the apex implantation catheter, the head end of the right chamber bag filling cavity is communicated with the right chamber bag, and the tail end of the right chamber bag filling cavity is communicated with a right chamber bag injection tube through the apex implantation catheter.
The right chamber pressure measuring port is adjacently arranged in front of the right chamber inner sac through the apex insertion catheter, the right chamber pressure measuring cavity is arranged in the apex insertion catheter, the head end of the right chamber pressure measuring cavity is communicated with the right chamber pressure measuring port, and the tail end of the right chamber pressure measuring cavity is communicated with the right chamber pressure measuring pipe through the apex insertion catheter.
The tip of the transapical imbedding catheter is provided with a temperature probe for measuring pulmonary artery blood flow by matching with a thermal dilution method, the electrical connection temperature probe is embedded with a wire in the transapical imbedding catheter, and the tail end of the wire is provided with a signal interface through the transapical imbedding catheter.
The transapical right ventricle saccule catheter also comprises an intraesophageal catheter, the head end of the intraesophageal catheter is provided with an ultrasonic probe for measuring heart and great vessel artery parameters by Doppler technology, a wire is embedded in the intraesophageal catheter, and the tail end of the wire is provided with a signal interface outside the intraesophageal catheter.
The inner surface and the outer surface of the right indoor bag of the transapical imbedded catheter are coated with an anticoagulant coating.
The length of the right indoor bag is 4-6cm when the right indoor bag is collapsed, the right indoor bag is spherical after filling, and the maximum volume is smaller than 80ml.
The distance between the pressure measuring port of the right chamber and the head end of the transapical catheter is 5-10cm.
The transapical right ventricular balloon catheter is used in the following manner:
S1, preparing a right indoor bag for examination, and exhausting a sheath tube, a right indoor bag filling cavity, a pulmonary artery pressure measuring cavity and a right indoor pressure measuring cavity.
S2, puncturing, namely prefabricating purse-string suture at the position of the heart tip corresponding to the right ventricle, puncturing, placing a guide wire, placing a sheath tube into the right ventricle under the guide of the guide wire, and tightening the purse for temporary fixation.
And S3, placing the heart apex placement catheter, namely connecting a pulmonary artery pressure measuring tube and a right ventricular pressure measuring tube with pressure measuring equipment respectively, placing the heart apex placement catheter through a sheath tube inner cavity, observing the pressure values and waveforms of a pulmonary artery pressure measuring port and a right ventricular pressure measuring port in real time, and after the right ventricular sac completely enters the right ventricle, pulling out the sheath tube, and tightening the purse again for temporary fixation.
And S4, positioning the right indoor bag, namely filling 5-10ml of liquid into the right indoor bag under the auxiliary premise of VA-ECMO, slowly backing the right indoor bag back through the apex of the heart and placing a catheter into the right indoor bag, enabling the right indoor bag to cling to the inner wall of the right ventricle, and immediately stopping backing.
And S5, flow monitoring, namely calibrating the pulmonary blood flow through a thermal dilution method by using a temperature probe and a flow calibrating device, and continuously monitoring the pulmonary blood flow according to the pressure change of the pulmonary artery, or placing an ultrasonic probe on an esophageal catheter at a position corresponding to the heart of the esophagus, and measuring the pulmonary blood flow or the heart function through a Doppler technology.
And S6, regulating pulmonary artery flow, namely injecting a small amount of liquid into the right indoor sac in a sub-mode under the monitoring, regulating the right ventricular output, simultaneously regulating the VA-ECMO flow, and regulating pulmonary artery pressure or pulmonary blood flow to an expected value.
S7, after the patient' S illness state is restored to be stable, slowly and slightly evacuating the liquid in the right indoor sac in a small number of times, simultaneously reducing the VA-ECMO flow, and finally pulling out the transapical catheterization.
And the tail ends of the pulmonary artery pressure measuring tube, the right ventricular sac injection tube and the right ventricular pressure measuring tube are respectively connected with an elastic valve filling port.
The right chamber bag injection tube is communicated with a safety relief valve, and the threshold value of the safety relief valve is smaller than the pressure of the maximum volume of the right chamber bag.
The invention has the beneficial effects that:
1. the invention is matched with VA-ECMO for use when pulmonary arterial hypertension occurs in the lung transplantation operation, and can be operated minimally invasively at the apex of the heart under naked eyes, thereby being convenient and fast and having reliable effect;
2. After the positioning is finished, the right indoor bag is positioned in the right ventricle, and the right indoor bag is filled with a proper amount of liquid, so that the right ventricle space is occupied, the right ventricle blood output is reduced, the pulmonary artery pressure and the pulmonary blood flow can be effectively reduced, the left ventricle capacity load is effectively reduced, meanwhile, the right ventricle anterior right atrium great vein pressure is improved, the VA-ECMO flow can be effectively improved, and the body circulation stability is ensured.
3. And by matching with a thermal dilution method or ultrasonic monitoring, the VA-ECMO and the left heart blood flow value are quantified, and the situation that the VA-ECMO flow is unknown only and the left heart flow is unknown in the past is changed, so that the circulation control is clearer and clearer.
4. Through VA-ECMO flow regulation and lung blood flow regulation, the single-supply lung breathing period during lung transplantation can be effectively reduced, the single-supply lung bears capacity load during the whole heart flow period, and PGD (pulse Width modulation) of the first side supply lung transplantation can be effectively avoided.
5. After pulmonary artery high pressure transplantation operation caused by pulmonary vascular occlusion, the method can effectively improve VA-ECMO flow, regulate left ventricular blood flow, avoid atrophic left ventricular failure, gradually reduce VA-ECMO flow, regulate left ventricular flow, and gradually recover the left ventricle to a normal state after exercise, thereby winning recovery time for the left ventricle.
Drawings
FIG. 1 is a block diagram of a first embodiment of the present invention;
FIG. 2 is a diagram showing the construction of a second embodiment of the present invention;
FIG. 3 is a schematic diagram of a heart structure;
FIG. 4 is a schematic view of the transapical catheter of the present invention, wherein the left view is a schematic view of the transapical catheter to establish an insertion channel, and the right view is a schematic view of the transapical catheter;
FIG. 5 is a schematic view of the invention in the position for adjusting the transapical catheter, wherein the left view is a schematic view of the sheath being withdrawn and the transapical catheter remaining, and the right view is a schematic view of the right ventricular balloon being filled with fluid and retracted against the right ventricular wall;
FIG. 6 is a schematic view of the present invention in use, wherein the left view is a graph of the relationship between the present invention and heart when in use, and the right view is a graph of the present invention cooperating with VA-ECMO when in use;
FIG. 7 is a schematic diagram of a thermal dilution method for measuring blood flow according to a first embodiment of the invention.
In the drawing the view of the figure,
1. Placing a catheter through the apex of the heart, measuring pressure of 11, pulmonary artery, 12, right indoor bag, 13, right indoor pressure measuring port, 14, temperature probe, 15, esophageal catheter, 16, ultrasonic probe;
2. Heart, 21, central veins (including jugular, superior and inferior vena cava), 22, right atrium, 23, right ventricle, 24, pulmonary artery, 25, pulmonary vein, 26, left atrium, 27, left ventricle, 28, aorta;
31. ECMO host, 32, ECMO venous catheterization, 33, ECMO arterial catheterization;
Detailed Description
The present invention will be further described with reference to the following examples in order to better understand the technical solutions of the present invention and to make the above features, objects and advantages of the present invention more clearly understood. The examples are only for illustrating the present invention and are not intended to limit the scope of the present invention.
As shown in fig. 1 and 2, the transapical right ventricular balloon catheter includes a transapical deployment catheter 1. The transapical right ventricle sacculus pipe is multi-cavity pipeline, and anterior segment multi-cavity pipeline gathers an organic wholely, forms transapical catheterization 1, and multi-cavity pipeline is put into the afterbody bifurcation of catheter 1 at transapical catheterization, forms the operation pipeline that communicates with corresponding cavity way in proper order for monitor the pressure of corresponding cavity way or pour into liquid to corresponding bag body.
The outer diameter of the transapical imbedding catheter 1 is circular, the head end is provided with a pulmonary artery pressure measuring port 11, a pulmonary artery pressure measuring cavity is arranged in the transapical imbedding catheter 1, and the tail end of the pulmonary artery pressure measuring cavity is provided with a pulmonary artery pressure measuring pipe in a communicating way by the transapical imbedding catheter 1. The corresponding pressure monitoring pipeline is filled with liquid (heparinized physiological saline) and marked with zero, and the pressure monitoring pipeline is connected with pressure monitoring equipment through a pulmonary artery pressure measuring pipe, so that the pressure monitoring can be carried out on the pulmonary artery pressure measuring port 11. By monitoring the pressure of the pulmonary artery pressure measuring port 11, the position of the head end of the transapical catheter 1 can be well judged, and the transapical catheter 1 at the rear can be smoothly guided to move forward in the cavity of the heart 2 after the transapical catheter is placed in the heart 2.
Specifically, the pulmonary artery pressure measuring port 11 is arranged at a position 0-20mm away from the tip opening at the forefront end of the transapical imbedding catheter 1, and the closer the pulmonary artery pressure measuring port 11 is to the tip opening at the forefront end of the transapical imbedding catheter 1, the better the closer the pulmonary artery pressure measuring port 11 is, so that the head end position of the pulmonary artery pressure measuring port 11 can be represented more accurately. By pressure monitoring, the specific position of the pulmonary artery pressure measuring port 11 in the cardiovascular system can be judged according to the pressure and waveform characteristics, so that the forward or backward operation of the transapical catheter 1 is guided, and the specific position of the foremost end of the transapical catheter 1 in the cardiac cavity is helped to be determined.
The right indoor bag 12 is arranged around the rear of the pulmonary artery pressure measuring port 11 by the transapical imbedding catheter 1, a right indoor bag filling cavity is arranged in the transapical imbedding catheter 1, the head end of the right indoor bag 12 is communicated with the right indoor bag, and the tail end of the right indoor bag filling cavity is communicated with the transapical imbedding catheter 1 to form a right indoor bag injection tube. The distance of the right indoor bag 12 from the pulmonary artery pressure measuring port 11 is optimally 5-10cm, and the length is longer than the length of the outflow channel of the right ventricle 23 by about 2cm, so that the pulmonary artery pressure measuring port 11 can enter the pulmonary artery 24 when the right indoor bag 12 is positioned in the right ventricle 23.
The right indoor bag 12 is completely and annularly attached to the outer wall of the transapical imbedded catheter 1 in a non-inflated and completely exhausted state. Avoiding the formation of wrinkles on the wall of the right indoor bag 12 when the bag wall is not inflated and completely exhausted, and avoiding the rupture of the wall of the right indoor bag 12 when the bag wall is placed through the sheath. When in use, the right indoor bag 12 needs to be filled with a proper amount of liquid, preferably physiological saline, sodium lactate ringer's solution, sodium acetate ringer's solution and the like. The right indoor bag 12 is in a sphere-like shape after being filled and is positioned at the position of the right ventricle close to the apex of the heart, so that the resistance interference on the blood flow is reduced, and the blood flow channel is prevented from being blocked completely.
The maximum volume of the right indoor pouch 12 is less than 80ml. In specific implementation, the right indoor bag 12 is positioned in the right ventricle 23 of the patient, the normal value of the diastolic volume of the right ventricle 23 is 130-150ml, the maximum volume of the right indoor bag 12 is selected to be smaller than 80ml, and the right indoor bag 12 is selected to be filled with proper liquid with different volumes under vital sign monitoring according to different specific illness states of different patients when in use, so that the inner cavity of the right ventricle 23 is occupied to a certain extent, but the diastolic volume of the inner cavity of the right ventricle 23 is required to be smaller, and the complete blockage of the inner cavity of the right ventricle 23 is avoided, so that the transaxial blood flow passage is completely blocked.
The length of the right indoor bag 12 is smaller than 6cm and 7-11cm of the inner cavity of the adult right ventricle 23, so that the right indoor bag 12 can be completely contained in the inner cavity of the right ventricle 23.
The right indoor bag 12 is preferably made of medical materials such as silica gel with soft material and excellent elasticity, so that the bag wall is smooth and thin, and after a proper amount of liquid is injected, the inner wall of the right ventricle 23 possibly presses the outer wall of the right indoor bag 12 when contracting, the pressure in the bag cavity is smaller, the texture is soft, and the friction damage to the inner wall of the right ventricle 23 can be reduced.
The transapical imbedding catheter 1 is adjacently provided with a right chamber pressure measuring port 13 in front of the right chamber inner bag 12, a right chamber pressure measuring cavity is arranged in the transapical imbedding catheter 1, the head end of the right chamber pressure measuring cavity is communicated with the right chamber pressure measuring port 13, and the tail end of the transapical imbedding catheter 1 is communicated with a right chamber pressure measuring pipe. The pressure monitoring pipeline of the corresponding pipe is filled with liquid (heparinized normal saline) and marked with zero, the pressure monitoring device is connected through the pressure measuring pipe of the right chamber, the pressure monitoring can be carried out on the pressure measuring port 13 of the right chamber, the specific part of the pressure measuring port 13 of the right chamber in the heart chamber can be judged according to the pressure and waveform characteristics, and the operation of advancing or retreating the catheter 1 is carried out through the apex of the heart in a matching manner, so that the inner capsule 12 of the right chamber is finally determined to be positioned in the cavity of the right ventricle 23.
Specifically, the right chamber pressure measuring port 13 is adjacently disposed in front of the right chamber bladder 12, the length of the right chamber bladder 12 is less than 6cm, the adult size is longer, the child is shorter, and the length of the right ventricle 23 is suitable for averaging with the corresponding age and is less than the length of the right ventricle 23. Taking an adult as an example, the length of the inner cavity of the right ventricle 23 of a normal adult is 7-11cm, the length of the right indoor bag 12 is less than 6cm, and the optimal length is 4.5-5.5cm, so that the right indoor bag 12 can be positioned in the right ventricle 23 cavity.
As shown in fig. 1, the head end of the transapical catheter 1 is provided with a temperature probe 14 for measuring pulmonary artery blood flow in cooperation with a thermal dilution method, the electrical connection temperature probe 14 is embedded with a wire in the transapical catheter 1, and the tail end of the wire is provided with a signal interface through the transapical catheter 1. 10-15ml of ice water is injected through the right ventricular pressure measuring port 13, the ice water is mixed with blood in the jugular vein or the right atrium, the temperature of the mixed blood can be reduced, the temperature probe 14 senses the temperature change, and the temperature flow calculating device is connected through the signal interface to measure and calculate the bleeding flow.
As shown in fig. 7:
the calculation formula is as follows:
Wherein Q is the flow rate required, and is also the cardiac output in the current environment;
T b is the blood temperature of the patient, and the temperature measured by the flow sensor (16) can be completed by observing the temperature before ice water is injected;
t i is the injection temperature, i.e. the temperature of the ice-water mixture is 0 ℃;
V i is the volume of the injection, typically within 10 ml;
K is a correction coefficient and a constant value, and certain compensation difference exists according to the difference of the equipment;
Where Δ bTXdt is the area under the thermal dilution curve, which can be calculated directly by the apparatus, is a known method, and the clinic is widely used in PICOO and will not be described here.
As shown in fig. 2, the transapical right ventricular balloon catheter further comprises an intraesophageal catheter 15, wherein an ultrasonic probe 16 for measuring parameters of heart and great vessel artery by doppler technique is arranged at the head end of the intraesophageal catheter 15, a wire is embedded in the intraesophageal catheter 15, and a signal interface is arranged at the tail end of the wire out of the intraesophageal catheter 15. The ultrasonic probe 16 arranged on the esophageal catheter 15 is placed in the esophagus corresponding to the back position of the heart, then the multi-ultrasonic Doppler technology is communicated from the back of the heart, the flow of the pulmonary artery is monitored, and after the position is adjusted, other large blood vessel flow data such as left and right cardiac output, myocardial wall activity state and the like can be monitored.
The intraesophageal catheter 15 may be configured as a gastric tube that adjusts the ultrasound probe 16 to a position proximal to the back of the heart, allowing the ultrasound probe 16 to detect various cuts of the heart, acquiring various clinical cardiac kinetic data including pulmonary artery flow, cardiac stroke volume, and the like. Clinically, TEE devices exist, and the technology is the same as that and will not be described in detail.
Further, the inner and outer surfaces of the transapical imbedded catheter 1 and the outer surface of the right indoor bag 12 are coated with an anticoagulant coating. Can prevent blood from solidifying to form thrombus on the inner and outer surfaces of the cavity of the transapical imbedded catheter 1 and the outer surface of the right indoor bag 12, and avoid the risk of blocking pulmonary artery branches after potential thrombus is formed and falls off.
Further, the length of the right indoor bladder 12 when deflated is 4-6cm, preferably 5cm. The total length of the right ventricle 23 is about 7-11cm, and the length of the right indoor bag 12 is smaller than the length, so that when the right indoor bag 12 is positioned in the right ventricle 23 tightly attached to the inner wall of the right ventricle 23, the right indoor pressure measuring port 13 is ensured to be positioned in the cavity of the right ventricle and not enter the pulmonary artery 24. The right indoor bag 12 is ball-like after filling, the maximum volume is less than 80ml, and the diastole volume is less than 130-150ml of the right ventricle 23 of a normal adult, so that the right indoor bag 12 can not block the blood inlet (tricuspid valve) and the bleeding port (pulmonary valve) of the right ventricle 23 after injecting liquid.
When the device is used, the right indoor bag 12 is positioned in a cavity gap near the apex of the heart of the right ventricle 23 and is tightly attached to the inner wall of the right ventricle 23, so that the maximum volume of the right ventricle 23 at the end diastole is not changed, the blood storage of the right ventricle 23 in the end diastole is reduced due to the occupation, meanwhile, the volume of the right ventricle 23 at the end systole is passively increased, the pulsating blood flow of the right ventricle 23 at each time is reduced, the output of the right ventricle 23 is reduced, the blood flow of the pulmonary artery 24 is reduced, the pressure of the pulmonary artery 24 is reduced, and finally the acting of the left ventricle 27 is reduced.
Further, the method comprises the steps of, the distance between the right chamber pressure measuring port 13 and the head end of the transapical imbedded catheter 1 is 5-10cm, and 8cm is optimal. The length of the right ventricular 23 diastolic chamber is about 9cm, minus the length of the right ventricular chamber 12 by about 5cm, and the difference in length is about 4cm. The difference is smaller than the distance between the right ventricular pressure measuring port 13 and the head end of the transapical imbedded catheter 1, so that the right ventricular pressure measuring port 13 can enter the pulmonary artery 24 through the pulmonary artery 24 valve after the right ventricular bladder 12 is correctly positioned.
As shown in FIG. 3, the heart is basically structurally characterized in that the heart chamber comprises a right atrium 22, a right ventricle 23, a left atrium 26 and a left ventricle 27, and the valves comprise a tricuspid valve positioned at the communication part of the right atrium 22 and the right ventricle 23, a pulmonary valve positioned at the outlet part of the right ventricle 23, a mitral valve positioned at the communication part of the left atrium 26 and the left ventricle 27 and an aortic valve positioned at the outlet part of the left ventricle 27.
The blood flow path is systemic capillary vein- & gtsystemic venule- & gtsystemic great vein (including jugular vein, femoral vein, axillary vein, etc.), central vein 21 (superior vena cava, inferior vena cava) & gtright atrium 22- & gttricuspid valve- & gtright ventricle 23- & gtpulmonary valve- & gtpulmonary artery 24- & gtpulmonary arteriole- & gtpulmonary capillary vein- & pulmonary vena arteriole- & gtpulmonary vein 25- & gtleft atrium 26- & mitral- & gtleft ventricle 27- & gtaortic valve- & aortic valve- & gtaortic 28 (thoracic aorta, abdominal aorta- & gtsystemic great artery (including femoral artery, carotid artery, brachial artery, etc.), systemic arteriole- & gtsystemic capillary artery- & systemic capillary vein.
The pressure of each chamber of the heart (related to the patent) is characterized in that the pressure of the right ventricle 23 is rapidly increased in the systolic period, the pressure of the right ventricle 23 is rapidly reduced in the diastolic period, the descending branch has an obvious notch, the remarkable characteristic is that the diastolic pressure is obviously lower than the systolic pressure, the systolic pressure is normally 20-30mmHg, the diastolic pressure is 0-5mmHg, and even if the diastolic pressure of the right ventricle 23 of a patient with pulmonary arterial hypertension is generally not more than 15mmHg. The pulmonary artery 24 pressure has obvious peak value, the descending branch has obvious notch, the pulmonary artery 24 systolic pressure is similar to the right ventricle 23 systolic pressure, but the pulmonary artery 24 diastolic pressure is obviously larger than the right ventricle 23 diastolic pressure, and the pressure difference is more than 10 mmHg.
The puncture tube-placing part is a cardiac apex part, the region is positioned at the tail ends of a heart rhythm conduction system and a myocardial blood supply and coronary artery system, the puncture risk is minimum, and the puncture tube-placing part is a first choice for minimally invasive heart operations, such as replacement of a valve at the apex of a heart and fixation of valve prolapse, and the apex of the heart is used as a puncture operation part.
The transapical right ventricular balloon catheter is applied to double-lung transplantation operation, and the main indication is that the pulmonary arterial hypertension before operation is acceptable, and the pulmonary arterial hypertension which is difficult to control after one side of pulmonary artery is blocked in operation is common in double-lung transplantation. The current methods for reducing pulmonary hypertension after this condition are cardiotonic, NO inhalation, and centered VA-ECMO, but have very limited efficacy.
The percutaneous apex right ventricle balloon catheter needs to be established with VA-ECMO assistance before use, and the use mode is as follows:
S1, preparing a right indoor bag 12 for examination, and exhausting a sheath tube, a right indoor bag filling cavity, a pulmonary artery pressure measuring cavity and a right indoor pressure measuring cavity. At this time, the puncture needle and the guide wire are required to be equipped, the guide sheath is a common puncture fitting in clinic, the puncture needle is used for puncturing at the cardiac apex, the guide wire is a flexible spring guide wire structure with a flexible head, the guide wire can be ensured not to damage the inner wall of the cardiac chamber when being placed into the cardiac chamber, and the safety is ensured. The sheath tube is of a tubular structure with a one-way membrane valve at the tail part, and can be inserted into the transapical insertion catheter 1 through the sheath tube, but blood cannot flow out through the tail part and is used as a passage for the transapical insertion catheter 1 to be inserted into the right ventricle 23 and the pulmonary artery 24.
S2, puncturing, namely prefabricating purse-string suture at the position of the heart tip corresponding to the right ventricle 23, wherein a puncture needle punctures in the prefabricating purse-string region at the heart tip of the right ventricle 23 and enters the right ventricle 23. The inner cavity of the puncture needle is larger than the outer diameter of the guide wire, when the puncture needle is connected with the injector to draw back blood smoothly, the guide wire is placed through the puncture needle, and the guide wire is slowly placed into the pulmonary artery under the condition that the right ventricle 23 and the pulmonary artery 24 are visible with naked eyes. The puncture needle is pulled out, the sheath tube is placed into the right ventricle 23 under the guidance of the guide wire, and the purse string is tightened for temporary fixation.
S3, placing the transapical placement catheter 1, namely connecting a pulmonary artery pressure measuring tube and a right ventricular pressure measuring tube with pressure measuring equipment respectively, placing the transapical placement catheter 1 through a sheath tube inner cavity, observing the pressure values and waveforms of the pulmonary artery pressure measuring port 11 and the right ventricular pressure measuring port 13 in real time, and after the right ventricular sac 12 completely enters the right ventricle 23, pulling out the sheath tube, and tightening the purse again for knotting and fixing. To ensure that the right indoor bag 12 completely enters the right ventricle 23, graduations can be prefabricated on the catheter 1 corresponding to the apex of the heart behind the right indoor bag 12, and the implantation depth is larger than the wall thickness of the right ventricle 23.
And S4, positioning the right indoor bag 12, namely filling 5-10ml of liquid into the right indoor bag 12 under the auxiliary premise of VA-ECMO, slowly backing up and putting the catheter 1 through the apex of the heart, enabling the right indoor bag 12 to cling to the inner wall of the right ventricle 23, and immediately stopping backing up. After the right indoor bag 12 is filled with liquid, the volume becomes larger, obvious resistance is generated when the right indoor bag is retreated to be close to the inner wall of the apex of the heart of the right ventricle 23, and the retreating can be stopped, of course, the right indoor bag 12 is observed at the moment of retreating, the apex of the heart at the rear of the right indoor bag 12 is put into the catheter 1 for prefabrication scale, and misoperation is avoided to pull out the right indoor bag 12.
S5, flow monitoring, namely calibrating the pulmonary blood flow by a thermal dilution method through the temperature probe 14 and the flow calibration equipment, and continuously monitoring the pulmonary blood flow according to the pressure change of the pulmonary artery. When the lung blood flow is calibrated, 5-10ml of ice water is most preferably used, the temperature is zero, and the lung blood flow is easy to obtain.
Or the ultrasonic probe 16 on the intraesophageal catheter 15 is placed in the esophagus corresponding to the heart position, and the lung blood flow or heart function is measured by Doppler technology.
And S6, regulating pulmonary artery flow, namely injecting a small amount of liquid into the right indoor sac 12 for times under the monitoring, regulating the output quantity of the right ventricle 23, and simultaneously regulating the VA-ECMO flow to regulate pulmonary artery pressure or pulmonary blood flow to an expected value.
As shown in the right diagram of fig. 6, after the extracorporeal circulation is established, the blood circulation path is two parallel paths:
① Venous system → right atrium 22 → right ventricle 23 → pulmonary artery 24 → lung → left atrium 26 → left ventricle 27 → arterial system → venous system.
② Venous System → Right atrium 22 → ECMO venous catheter 32 → ECMO host 31 → ECMO arterial catheter 33 → arterial System → venous System.
The two parts together play the role of pumping the oxygenated venous blood into the artery, and the two parts cooperate to ensure the blood supply of all organs and tissues of the body. When the right indoor sac 12 is injected, the output quantity of the right ventricle 23 is regulated down, the blood flow of the heart and lung is reduced, and the VA-ECMO flow is regulated simultaneously in time, so that the blood supply of each organ and tissue of the body is ensured.
S7, after the patient' S illness state is restored to be stable, slowly and slightly evacuating the liquid in the right indoor bag 12 in a small number of times, simultaneously reducing the VA-ECMO flow, and finally pulling out the transapical catheter 1.
According to the condition, the extraction of the transapical insertion catheter 1 is divided into two cases:
① If the left heart is good, PGD (based on whether or not macroscopic lung water occurs) does not occur after the double lung is opened, the liquid in the right indoor bag 12 can be pumped down in several times before the chest is closed, and finally the apex of the heart is pulled out to insert the catheter 1. After tube drawing, whether the puncture point is oozed or not needs to be observed, and if necessary, a needle is sewn to close the puncture point.
② In patients with PGD, or left heart atrophy, the apex placement catheter 1 should be kept. When closing chest, a certain degree of looseness is reserved for the heart apex imbedded catheter 1, and the standard is that the beating of the heart 2 is not affected. The tail of the apex imbedding catheter 1 is led out through the chest wall rib clearance via the precordial region, a cutting hole is led out by aseptic treatment, and the dressing is covered, so that the relevant data such as pulmonary artery pressure, right ventricle pressure and the like are continuously monitored.
In PGD patients, when the transplanted lung function is recovered and the lung water is disappeared, the liquid in the right indoor bag 12 can be pumped out in a divided way, and the heart apex is pulled out to be put into the catheter 1. After tube drawing, the puncture point blood seepage condition needs to be observed, the puncture point of the heart tip can be closed by the prefabricated purse string suture under normal conditions, no treatment is needed, and if the puncture point blood seepage is obvious, if necessary, the small incision in the precordial region is closed by the suture of the puncture point under direct vision. This is also a routine procedure in chest surgery and will not be described in detail here.
In patients with left heart atrophy, the apex placement catheter 1 needs to be kept for a longer time, and the liquid in the right indoor sac 12 is pumped out in small amounts (5-10 ml each time and 1-3 days each time, depending on the illness state) in different times, the rotation speed of the VA-ECMO is correspondingly slightly reduced, the flow of the VA-ECMO is reduced, and the preload of the left ventricle 27 is slowly increased. The operation is repeated, and the atrophic heart is subjected to functional exercise by multiple times of adaptive exercise within 1-2 months, so that the wall thickness of the left ventricle cardiac muscle gradually returns to a normal state. The right indoor sac 12 is basically emptied of liquid, the left ventricle 27 is basically restored in function, and the apex of the heart can be pulled out to be placed into the catheter 1.
After the heart tip is pulled out and the catheter 1 is placed, the VA-ECMO flow can be regulated to be smaller according to the disease condition until the VA-ECMO is pulled out, and the treatment is finished.
As shown in fig. 4-7, is described in detail in connection with specific operations. An embodiment of the figure can be completed under the TEE monitoring heart chamber, and an embodiment of the figure 2 can be completed under the TEE monitoring heart chamber by firstly placing the ultrasonic probe 16 of the intraesophageal catheter 15 behind the corresponding heart of the esophagus:
The left view of fig. 4 shows a schematic view of the sheath being placed in the right ventricle 23 and the guide wire being pulled out, the apex placement catheter 1 not yet entering the heart chamber, and no pressure feature. At this time, the pre-buried purse-string suture is wrapped on the outer ring of the sheath tube, and the puncture Kong Shoujin is temporarily fixed and closed on the outer wall of the sheath tube. The specific puncture process comprises the steps of slightly fixing the apex of a heart, penetrating a puncture needle into a right ventricle, placing a guide wire into the inner cavity of the puncture needle, pulling out the puncture needle, injecting a sheath tube into the right ventricle under the guidance of the guide wire, and finally pulling out the guide wire to fix the sheath tube.
As shown in the right graph of fig. 4, the apex placement catheter 1 is placed into the right ventricle 23 through the sheath lumen to a corresponding depth, the pulmonary artery pressure measurement port 11 at the head end of the apex placement catheter 1 enters the pulmonary artery 24 through the pulmonary artery 24 valve, the right indoor sac 12 enters the right ventricle 23, and the right room pressure measurement port 13 is located in the right ventricle 23. At this time, the pulmonary artery pressure measurement port 11 is represented by a pulmonary artery 24 pressure waveform and characteristic, and the right ventricular pressure measurement port 13 is represented by a right ventricular 23 pressure waveform and characteristic.
As shown in the left graph of FIG. 5, the sheath is pulled out, the preformed purse string front is further tightened, and the puncture is closed, at this time, the pulmonary artery pressure measurement port 11 is still in the pulmonary artery 24 and shows the pressure waveform and characteristics of the pulmonary artery 24, and at the same time, the right ventricular pressure measurement port 13 is still in the right ventricle 23 and shows the pressure waveform and characteristics of the right ventricle 23.
As shown in the right diagram of fig. 5, the right indoor bag 12 is filled with a small amount of liquid, and at this time, the right indoor bag 12 is inflated, and the apex of the heart is placed in the catheter 1 and retreated until the wall of the right indoor bag 12 is attached to the apex inner wall of the right ventricle 23. This may be done under ultrasound to right heart chamber observation.
As shown in the left graph of FIG. 6, the right indoor bladder 12 is filled with the appropriate fluid (in coordination with the VA-ECMO to increase rotational speed) to decrease the amount of right ventricular 23 stroke and decrease the amount of right ventricular 23 output. The flow rate into the pulmonary artery 24 is reduced, the systolic pressure and the diastolic pressure of the pulmonary artery pressure measured by the pulmonary artery pressure measuring port 11 are reduced, while the right ventricular pressure measuring port 13 is positioned in the right ventricle 23, the systolic pressure of the right ventricle 23 is not reduced, even slightly increased, but the pump action caused by the diastole of the right ventricle 23 is reduced due to the occupation of the right ventricular sac 12 in the diastole, and the diastolic pressure of the right ventricle 23 is increased.
As shown in the right hand side of fig. 6, a state diagram is applied after the filling of the right indoor bladder 12 with liquid is completed. At this time, the heart pump function and the VA-ECMO pump function work in parallel, and venous blood is oxygenated and pumped into arteries to supply blood for various organs and tissues.
Furthermore, the tail ends of the pulmonary artery pressure measuring tube, the right ventricular sac injection tube and the right ventricular pressure measuring tube are all connected and provided with elastic valve filling ports. After filling the liquid, the filling port can be closed, so that the stability of the inner volume of the right indoor bag 12 is ensured, and the operation is convenient. When the volume needs to be reduced, the reverse operation is only needed.
Further, the right chamber capsule injection tube is provided with a safety relief valve in a communicating manner, and the threshold value of the safety relief valve is smaller than the pressure of the maximum volume of the right chamber capsule 12. The threshold value of the safety relief valve is adjusted and set according to the material, length, wall thickness and thickness of the right indoor bag 12 which is a specific product and is placed into the catheter 1 through the apex, the pressure of the right indoor bag 12 is limited, the inner volume of the right indoor bag 12 is ensured not to exceed the maximum volume set by the product, and the maximum volume is smaller than 80ml, and is preferably set to be 70ml.
The above-described embodiments are merely illustrative of the principles of the present application and their effectiveness, and are not intended to limit the present application. Modifications and variations may be made to the above-described embodiments by those skilled in the art without departing from the spirit and scope of the present application. Accordingly, it is intended that all equivalent modifications and variations which a person having ordinary skill in the art would accomplish without departing from the spirit and technical spirit disclosed in the present patent application shall be covered by the claims of the present patent application.
Claims (9)
1. A transapical right ventricle balloon catheter, comprising a transapical imbedded catheter (1);
A pulmonary artery pressure measuring port (11) is arranged at the head end of the transapical imbedding catheter (1), a pulmonary artery pressure measuring cavity is arranged in the transapical imbedding catheter (1), and a pulmonary artery pressure measuring pipe is communicated with the transapical imbedding catheter (1) at the tail end of the pulmonary artery pressure measuring cavity;
A right indoor bag (12) is arranged around the rear of the pulmonary artery pressure measuring port (11) through the apex of the heart imbedding catheter (1), a right indoor bag filling cavity is arranged in the apex of the heart imbedding catheter (1), the head end of the right indoor bag (12) is communicated with the right indoor bag, and a right indoor bag injection pipe is arranged at the tail end of the apex of the heart imbedding catheter (1);
the right chamber pressure measuring port (13) is adjacently arranged in front of the right chamber inner bag (12) through the apex of the heart imbedding catheter (1), the right chamber pressure measuring cavity is arranged in the apex of the heart imbedding catheter (1), the head end of the right chamber pressure measuring cavity is communicated with the right chamber pressure measuring port (13), and the tail end of the right chamber pressure measuring cavity is communicated with the right chamber pressure measuring pipe through the apex of the heart imbedding catheter (1).
2. The transapical right ventricular balloon catheter according to claim 1, wherein the head end of the transapical catheter (1) is provided with a temperature probe (14) for measuring pulmonary artery blood flow in cooperation with a thermal dilution method, the electrical connection temperature probe (14) is embedded with a wire in the transapical catheter (1), and the tail end of the wire is provided with a signal interface through the transapical catheter (1).
3. The transcardiac right ventricular balloon catheter of claim 1 further comprising an intraesophageal catheter (15), wherein an ultrasound probe (16) for measuring heart and great vessel artery parameters by Doppler technique is disposed at the head end of the intraesophageal catheter (15), a wire is embedded in the intraesophageal catheter (15), and a signal interface is disposed at the tail end of the wire out of the intraesophageal catheter (15).
4. The transapical right ventricular balloon according to claim 1, wherein the transapical catheter (1) has an anticoagulant coating on the inner and outer surfaces and the right indoor balloon (12) has an outer surface.
5. The transapical right ventricular balloon catheter according to claim 1, wherein the right ventricular balloon (12) has a length of 4-6cm when deflated, is spheroid after filling, and has a maximum volume of less than 80ml.
6. The transapical right ventricular balloon catheter according to claim 1, wherein the right ventricular pressure measuring port (13) is placed at a distance of 5-10cm from the head end of the transapical implantation catheter (1).
7. The transapical right ventricular balloon catheter according to claim 1-6, wherein the method of use is as follows:
S1, preparing a right indoor bag (12) for examination, and exhausting a sheath tube, a right indoor bag filling cavity, a pulmonary artery pressure measuring cavity and a right indoor pressure measuring cavity;
S2, puncturing, namely prefabricating purse-string suture at the position of the heart tip corresponding to the right ventricle (23), puncturing, placing a guide wire, placing a sheath tube into the right ventricle (23) under the guidance of the guide wire, and tightening the purse for temporary fixation;
S3, placing the heart apex placement catheter (1), namely connecting a pulmonary artery pressure measuring tube and a right ventricular pressure measuring tube with pressure measuring equipment respectively, placing the heart apex placement catheter (1) through a sheath tube inner cavity, observing the pressure values and waveforms of a pulmonary artery pressure measuring port (11) and a right ventricular pressure measuring port (13) in real time, and after all the right ventricular bladder (12) enters a right ventricle (23), pulling out the sheath tube, and tightening the purse again for knotting and fixing;
s4, positioning the right indoor bag (12), namely filling 5-10ml of liquid into the right indoor bag (12) under the auxiliary premise of VA-ECMO, slowly backing the right indoor bag (12) to be tightly attached to the inner wall of the right ventricle (23) by placing the right indoor bag into the catheter (1) through the apex of the heart, and immediately stopping backing;
S5, flow monitoring, namely calibrating the pulmonary blood flow through a thermal dilution method by using a temperature probe (14) and flow calibrating equipment, and continuously monitoring the pulmonary blood flow according to the pressure change of pulmonary arteries, or placing an ultrasonic probe (16) on an intraesophageal catheter (15) at a position corresponding to the heart of the esophagus, and measuring the pulmonary blood flow or heart function through a Doppler technology;
s6, regulating pulmonary artery flow, namely injecting a small amount of liquid into the right indoor sac (12) for times under the monitoring, regulating the output quantity of the right ventricle (23), simultaneously regulating the VA-ECMO flow, and regulating pulmonary artery pressure or pulmonary blood flow to an expected value;
S7, after the patient' S illness state is restored to be stable, slowly and slightly evacuating the liquid in the right indoor bag (12) in a small amount, simultaneously adjusting the VA-ECMO flow, and finally pulling out the transapical imbedding catheter (1).
8. The transapical right ventricular balloon catheter according to claim 1, wherein the tail ends of the pulmonary artery pressure measuring tube, the right ventricular balloon injection tube and the right ventricular pressure measuring tube are respectively connected with an elastic valve filling port.
9. The transapical right ventricular balloon catheter according to claim 8, wherein the right ventricular balloon injection tube is provided with a safety relief valve in communication, the safety relief valve threshold being less than the pressure of the maximum volume of the right ventricular balloon (12).
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| CN202411053705.XA CN119950967A (en) | 2024-08-02 | 2024-08-02 | Transapical right ventricular balloon catheter |
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| CN202411053705.XA CN119950967A (en) | 2024-08-02 | 2024-08-02 | Transapical right ventricular balloon catheter |
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