Cardiac valve prosthesis and valve bracket thereof
Technical field
The present invention relates to medical instruments field, relate in particular to a kind of Cardiac valve prosthesis and valve bracket thereof.
Background technology
The cause of disease of valvular heart disease can be divided into congenital and two types of posteriorities.Congenital valvular heart disease is because valve dysplasia of when birth or hypoplasia.For example, aortic valve two lobeizations deformity can cause aortic stenosis or incompetence.If aortic stenosis or incompetence will seriously influence hemodynamics and change, cause the decline of carrying out property valvular function, cause heart failure at last, death.The roughly cause of disease of posteriority valvular heart disease can be divided into infection, degeneration, the change of rheumatism immunity or other reasons.Infection is that antibacterial passes through blood arrival heart inside and invades valve; Degeneration is that valve can be degenerated gradually, and is the most common with aortic valve along with the age is gradually long; The rheumatism immunity changes and mainly to refer to rheumatic heart disease, owing to streptococcal infection, causes immunoreation then and destroys cardiac valve.Other reason can comprise wound, the spontaneous fracture of chordae tendineae etc.The surgical operation therapy of treatment valvular heart disease mainly divides two kinds at present: a kind of is valvoplasty, promptly the valve of infringement is repaired; Another kind is a prosthetic valve replacement, promptly carries out the valve replacement with Cardiac valve prosthesis.
General prosthetic valve replacement all is to carry out through surgical operation.Though wound is bigger, operation is ripe, and success rate of operation is high, and complication rate is low.Cardiac valve prosthesis is categorized as two kinds at present, and a kind of is mechanical prosthetic valve, and a kind of is bioprosthetic valve.Bioprosthetic valve is far superior to mechanical prosthetic valve at aspects such as protection blood, the normal hemodynamics of maintenance; Bioprosthetic valve does not need lifelong oral anticoagulant, and mechanical prosthetic valve needs lifelong oral anticoagulant.Though bioprosthetic valve the persistency aspect be inferior to mechanical prosthetic valve, along with the progress of bioprosthetic valve design and lobe leaf anticalcium property process etc. techniques, the durability of bioprosthetic valve is progressively improve.Therefore, at present no matter the developing direction of valve is in the world or domestic all clear and definite, that is, the application of bioprosthetic valve will progressively replace mechanical prosthetic valve.
But there is following several respects problem in the existing manual biovalve orthopaedic surgical operations operating substitution process:
(1) size is not collapsible.Because all structures of all present bioprosthetic valve lobes are the rigidity structure, and artificial valve's model is limited, can't satisfy the valve demand of all ages and classes section, different weight and different lesions form fully.Under situation about can't mate fully, the doctor usually selects the artificial valve who is slightly less than lobe week for use, and its problem of bringing is, suture ligature is beaten easily and torn, and is fixing unstable, and nearly perivalvular leakage at a specified future date is generation easily also.If the model of selecting is excessive, then rigid snapping in caused tearing, damaging heart tissue easily.So in this case, must add and do lobe widening of the ring art, increase operation risk so undoubtedly.Particularly child or teenager because the lobe ring is little, are selected the bioprosthetic valve of ting model for use during operation; But growth along with age, body weight; The fixed valve of model can't further satisfy the hemodynamics demand, therefore need regularly carry out prosthetic valve replacement, to change bigger bioprosthetic valve; This has not only increased surgery cost, has also increased operation misery and operation risk;
(2) operation stitching difficulty.During the bioprosthetic valve displacement, valve is seamed to active position, needs 12~15 pins at least.Therefore, to how better, sew up quickly, reduce wound relevant and shortening cardiopulmonary bypass time etc. in the operation process, all have higher requirement with operation.Obviously, every many seam one pins all can increase operation risk.
And with respect to operating deficiency, the mode through intervene operation implanted prosthetic heart valve is little with its wound, obtain increasing concern to the invasive of human body is few.But so far, carry out valve replacement with the mode of Wicresoft's intervention apparatus and the problem that exists is more: (1) will be blocked the heart coronary artery opening if position, back, valve location is not good, cause acute myocardial infarction; (2) valve discharges the back if do not fix, and can directly come off, and slides into ascending aorta, causes ascending aorta and corresponding trunk bifurcated thereof to block.And the problems referred to above all might cause severe complications such as death, apoplexy, organ failure, and risk still is difficult to control, and risk can't remedy in case take place.
Summary of the invention
Main purpose of the present invention provides a kind of valve bracket, and the Cardiac valve prosthesis that is intended to this valve bracket is formed both can use at intervene operation, also can use the orthopaedic surgical operations implant surgery, and intervene operation was safer, and implant surgery is faster.
The invention provides a kind of valve bracket of Cardiac valve prosthesis, but said valve bracket is the elastic support of axial shrinkage, and said valve bracket is Openworks shape, the position of the corresponding lobe leaf of said valve bracket is provided with the U-shaped opening.
Preferably, the U-shaped lower opening portion of said valve bracket is provided with location structure.
Preferably, said location structure comprises by valve bracket and setting to the concave and the portion that is arranged with that forms that the said portion of being arranged with is used for cooperating with the position of valve, limits said valve bracket and slides.
Preferably, said location structure comprises the holding division that is outwards extended and formed by valve bracket, and said holding division is fastened on the place, position of valve, limits said valve bracket and slides.
Preferably, said location structure comprises and is used for the sutural margin that valve bracket positions in the position of valve.
Preferably, said sutural margin is half worker's type sutural margin, and the material of this sutural margin is the water swelling material; Perhaps said sutural margin is the undaform sutural margin.
Preferably, said U-shaped open top end extends upward extension also is set.
Preferably, the root of said U-shaped opening outwards extends.
Preferably, the lower end of the U-shaped mouth of said valve bracket is provided with the hollow out mouth.
Preferably, the upper end of said valve bracket is provided with connecting portion, form said U-shaped opening between the said two adjacent connecting portions, and the outer wall of connecting portion is provided with overlay film; The lower end of said valve bracket is inner buckle structure.
The present invention also provides a kind of Cardiac valve prosthesis; Comprise the lobe leaf and support the valve bracket of said lobe leaf; But said valve bracket is the elastic support of axial shrinkage, and said valve bracket is Openworks shape, and the position of the corresponding lobe leaf of valve bracket is provided with the U-shaped opening.
The present invention makes cardiac valve bulk metal structure significantly reduce through Openworks shape being set and having the valve bracket of U-shaped opening, very helps the loading and the recovery that get involved and implant, reduces the repellency of human body to the property implanted.
The location structure that the present invention also is provided with through the valve bracket outer wall, thus make that this location structure can be adaptive with the position of valve, and make valve bracket to locate better.
The present invention is also through being provided with sutural margin at the valve bracket outer wall, and the lobe ring that has solved the Cardiac valve prosthesis of existing surgical operation implantation effectively is the rigidity structure, limited grade of model and not of uniform size, the different contradiction of patient's heart lobe ring.Simultaneously, self-expanding cribbing (can adopt memorial alloy) has the growth with health, chronic expansion, the characteristic that adapts to voluntarily.In the operation process, operate simpler, more convenient, thereby reach the shortening operating time, reduce the purpose of operation risk.In addition, lobe body and lobe frame can dwindle better, more easily are positioned in the lobe ring, thereby avoid the possibility of row lobe widening of the ring art.
The present invention is also outwards extended through the root of U-shaped opening, thereby can strut the blood vessel of fitting with valve bracket, reduces Cardiac valve prosthesis behind life-time service, blocks up the probability of arteria coronaria because of fatigue damage.
The present invention also extends upward the extension that forms through the U-shaped open top end, make this extension better supplemental support at the ascending artery place, thereby make cardiac valve more stable, keep blood flow to.
The present invention also is provided with overlay film through the outer wall of U-shaped open top end, thereby can prevent that the metal termination from contacting with blood vessel, thus thorn mill blood vessel.
The present invention also is provided with the hollow out mouth corresponding with the arteria coronaria mouth through the bottom of U-shaped opening, thereby has guaranteed that blood flow is more smooth and easy, the generation of avoiding intermittent arteria coronaria to stop up.
Description of drawings
Fig. 1 is the structural representation of artificial cardiac valve first embodiment of the present invention;
Fig. 2 is the structural representation of artificial cardiac valve second embodiment of the present invention;
Fig. 3 is the structural representation of artificial cardiac valve the 3rd embodiment of the present invention;
Fig. 4 is the structural representation of artificial cardiac valve the 4th embodiment of the present invention;
Fig. 5 is the structural representation of artificial cardiac valve the 5th embodiment of the present invention;
Fig. 6 is the plan structure sketch map of Cardiac valve prosthesis shown in Figure 1;
Fig. 7 is the structural representation of artificial cardiac valve the 6th embodiment of the present invention;
Fig. 8 is the structural representation of artificial cardiac valve the 7th embodiment of the present invention.
The realization of the object of the invention, functional characteristics and advantage will combine embodiment, further specify with reference to accompanying drawing.
The specific embodiment
Further specify technical scheme of the present invention below in conjunction with Figure of description and specific embodiment.Should be appreciated that specific embodiment described herein only in order to explanation the present invention, and be not used in qualification the present invention.
With reference to Fig. 1, Fig. 1 is the structural representation of artificial cardiac valve first embodiment of the present invention.This inventive embodiments Cardiac valve prosthesis comprises lobe leaf 20 and supports the valve bracket 10 of lobe leaf 20.This valve bracket 10 is netted hollow out support, processes by elastomeric material, but and axial stretching.And lobe leaf 20 is processed by polymeric biomaterial or biological tissue.The position of valve bracket 10 corresponding lobe leaves is provided with U-shaped opening 30.This lobe leaf 20 is the 2-3 lobe.The embodiment of the invention is example with the aortic valve, and its lobe leaf is 3 lobes, and U-shaped opening 30 corresponding on the corresponding valve bracket 10 also is 3.The root of this U-shaped opening 30 extends to the over half of lobe leaf 20, extends to the root of lobe leaf 20 at most.
Valve bracket 10 comprises upper end 11 and lower end 12, and wherein lower end 12 is blood inflow place.Upper end 11 comprises the connecting portion 111 that lobe leaf 20 is set, and forms above-mentioned U-shaped opening 30 between this two connecting portion 111.The edge of this U-shaped opening 30 is the arc transition muscle that connect adjacent two connecting portions 111, so can reduce stress concentration, avoids valve bracket 10 to rupture because of tired.
The embodiment of the invention makes cardiac valve bulk metal structure significantly reduce through Openworks shape being set and having the valve bracket of U-shaped opening, very helps the loading and the recovery that get involved and implant, and reduces the repellency of human body to implant.
U-shaped opening 30 bottoms of above-mentioned valve bracket 10 also are provided with and are used for location structure that valve bracket 10 is cooperated with the position of valve, i.e. the junction of upper end 11 and lower end 12.In the present embodiment, this location structure comprises that the outer wall by valve bracket 10 sets to the concave and the portion that is arranged with 41 that forms, and this is arranged with portion 41 and can cooperates with the position of valve, limits said valve bracket and slides.Because valve bracket 10 is an elastic support; After so this is contracted in valve bracket in the sheath pipe and is transported to the place, position of valve; Valve bracket 10 elasticity are opened when breaking away from the sheath pipe, thus make this be arranged with portion 41 also can with the position of valve resilient engagement, restriction valve bracket 10 slides.
With reference to Fig. 2, Fig. 2 is the structural representation of artificial cardiac valve second embodiment of the present invention.Be with the difference of first embodiment: location structure can also only comprise that support extends the holding division 42 of formation outward; Perhaps combine to form the location structure of valve bracket by holding division 42 and the portion of being arranged with 41.When placing this cardiac valve with intervening mode, the lobe leaf of human body still is retained in original position (being the position of valve), and then holding division 42 can snap in human body lobe leaf wherein, the slip of restriction valve bracket, thereby the location of having realized valve bracket 10.If when holding division 42 combines with the portion of being arranged with 41, be arranged with portion 41 and also cooperate, further strengthened the location of valve bracket 10 with the position of valve.
With reference to Fig. 3, Fig. 3 is the structural representation of artificial cardiac valve the 3rd embodiment of the present invention.Be with the difference of first, second embodiment: location structure can also comprise sutural margin 43, and sutural margin 43 comprises suturing part 431, and sutural margin 43 is the ring-type adaptive with valve bracket 10, and is as shown in Figure 3.Sutural margin 43 is mainly used in the displacement of the Cardiac valve prosthesis in the orthopaedic surgical operations operation.For example, after heart is opened, with the excision of pathological changes valve, suturing part 431 and human body lobe circumferential weld are closed earlier, at last heart, thoracic cavity are sewed up.
The present invention is through being provided with sutural margin 43 on the outer wall of valve bracket 10, the lobe ring that has solved the Cardiac valve prosthesis of existing surgical operation implantation effectively is the rigidity structure, limited grade of model and not of uniform size, the different contradiction of patient's heart lobe ring.Simultaneously, self-expanding cribbing (can adopt memorial alloy) has the growth with health, chronic expansion, the characteristic that adapts to voluntarily.In the operation process, operate simpler, more convenient.Thereby reach the shortening operating time, reduce the purpose of operation risk.In addition, lobe body and lobe frame be self adaptation lobe ring size better, cooperates with human body lobe ring, thereby avoids the possibility of capable lobe widening of the ring art.
With reference to Fig. 4, Fig. 4 is the structural representation of artificial cardiac valve the 4th embodiment of the present invention.Be with the difference of the 3rd embodiment: this sutural margin 43 is the wave sutural margin.This sutural margin 43 is wavy, and the inwall of sutural margin 43 is fitted in the outer wall of valve bracket 10.Because the lobe ring of human body is not a smooth cross section; Therefore corrugated sutural margin can cooperate the lobe ring with out-of-flatness cross section; Sutural margin 43 through this undulate can be tightr with the lobe loop contacts, and can fit better with primary lobe, thereby reduce the probability of perivalvular leakage.This corrugated sutural margin 43 also is mainly used in the displacement of the Cardiac valve prosthesis in the orthopaedic surgical operations operation.For example, after heart is opened,, corrugated sutural margin 43 is closed with human body lobe circumferential weld, at last heart and thoracic cavity are sewed up earlier with the excision of pathological changes valve.
With reference to Fig. 5, Fig. 5 is the structural representation of artificial cardiac valve the 5th embodiment of the present invention.Be with the difference of the 3rd, the 4th embodiment: this sutural margin 43 is half worker's type sutural margin.This sutural margin 43 is provided with groove 432, and this groove 432 can be adaptive with the lobe ring.After heart is opened, with the excision of pathological changes valve, again Cardiac valve prosthesis is passed through groove 432 earlier; Be placed on the correct position of lobe ring; And this groove 432 also forms with the lobe ring and engage, and then groove 432 two sides and lobe circumferential weld are closed, at last with heart and thoracic cavity stitching.Because can forming with the lobe ring, the groove 432 of this sutural margin 43 engage, so, can reduce the sewing needle number, thereby reach the shortening operating time, the purpose of minimizing operation risk in that to carry out sutural margin 43 fashionable with the lobe circumferential weld.In addition, this sutural margin also has the characteristic of water-swellable, can fit tightly with tissue after the implantation.Perhaps this sutural margin also has the characteristic of climbing of valve bracket being covered gradually degraded with tissue.Therefore, the Cardiac valve prosthesis that has this half worker type sutural margin can also be used for the insertion type mode.For example, deliver to suitable position through conveyer device, sutural margin 43 water-swellables, thus groove 432 can snap in the human body valve wherein, and then expansible groove 432 can cooperate with the lobe ring position, makes between this Cardiac valve prosthesis and the lobe ring more firm.
Above-mentioned lobe leaf 20 is attached at the inner surface of valve bracket 10, and the two ends of lobe leaf 20 are fixed on the connecting portion 111.Lobe leaf 20 intersections are concave inward structure, so can reduce the amplitude of opening of lobe leaf 20, thereby reduce lobe leaf 20 stifled probabilities to arteria coronaria.As shown in Figure 6, the concave inward structure of lobe leaf 20 intersections makes the actual open scope of lobe leaf 20 be limited in the dotted line, reduced valve service time long after, lobe leaf 20 touches the probability of arteria coronaria.
Refer again to Fig. 1; The root of above-mentioned U-shaped opening 30 outwards extends and forms projection 31; This projection 31 can suitably strut the blood vessel of fitting with valve bracket 10; Increase the distance between arteria coronaria mouth and the lobe leaf 20, further reduce Cardiac valve prosthesis behind life-time service, block up the probability of arteria coronaria because of fatigue damage.And the bottom of U-shaped opening 30 is provided with the hollow out mouth 32 corresponding with the arteria coronaria mouth, thereby has guaranteed that blood flow is more smooth and easy, the generation of avoiding intermittent arteria coronaria to stop up.
In addition, the bottom of lower end 12 is inwardly drawn in and is inner buckle structure, thereby can avoid lower end compressing atrioventricular node, influences conductive cardiac tissue.
With reference to Fig. 7, Fig. 7 is the structural representation of artificial cardiac valve the 6th embodiment of the present invention.Be with the difference of first to the 5th embodiment: the outer wall of connecting portion 111 is provided with overlay film 112, and this overlay film 112 can prevent that the metal termination from contacting with blood vessel, thus thorn mill blood vessel.
With reference to Fig. 8, Fig. 8 is the structural representation of artificial cardiac valve the 7th embodiment of the present invention.Be with the difference of first to the 6th embodiment: the connecting portion 111 of upper end 11 upwards also is provided with extension 113, and this extension 113 better supplemental support makes this cardiac valve more stable at the ascending artery place, keep blood flow to; Whether and the axial length of valve bracket increases, and makes that in use discharging 2/3 valve bracket 10 back cardiac valve just starts working, operate the doctor this moment and can judge to regain according to cardiac valve working condition and position and reset.
To describe the process that Cardiac valve prosthesis of the present invention is placed through intervening mode below in detail.
Fixedly ear on valve bracket 10 connecting portions 111 (perhaps extension 112) is embedded in the locating slot of valve bracket fixing head outer wall (position of locating slot and shape are big or small to match with fixing ear); And then the sheath pipe is loaded in Cardiac valve prosthesis in the epitheca pipe in twitching.
Through conveyer device, get into through human body femoral artery otch, Cardiac valve prosthesis is sent to human aortic valve position.Discharge Cardiac valve prosthesis then, it is firm to make it the location.Sheath pipe far-end passes epitheca in the conveyer device; The relative motion of pipe and outer tube in the pulling epitheca just can be realized; When Cardiac valve prosthesis arrives the precalculated position, outer tube is drawn back certain distance, valve bracket 10 parts are exposed in the human body environment; And elder generation discharges 1/3 of valve bracket 10 length, then d/d part valve bracket 10 spreading under the body temperature effect.At this moment, can observe the effect in place of valve bracket 10 according to the situation behind the spreading.For example,, then can hold interior sheath, push away epitheca before the while, thereby drive the valve bracket fixing head if find that there is deviation the position.Because this moment, the fixedly ear of valve bracket 10 also was not released; It still is in the locating slot under the parcel of epitheca; The valve bracket fixing head just can spur fixedly that ear makes valve bracket 10 progress into epitheca, and under the extruding of epitheca inwall, valve bracket 10 can draw in until being got back to the state before discharging by the epitheca parcel fully gradually; Then reorientate again, discharge, until Cardiac valve prosthesis being fixed on best position.
The above is merely the preferred embodiments of the present invention; Be not so limit its claim; Every equivalent structure or equivalent flow process conversion that utilizes description of the present invention and accompanying drawing content to be done; Directly or indirectly be used in other relevant technical fields, all in like manner be included in the scope of patent protection of the present invention.