Name: direct re-implantation of left coronary artery into the aorta in adults with anomalous origin of left coronary artery from the pulmonary artery (alcapa)
Uploaded: 2017-04-24T15:00:00.000+00:00
Duration: 13 min 10 s
Description: Watch this Scientific Journal Video about Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA at JoVE

这项工作是由瑞士心血管基金会RT的资助。

该协议遵循苏黎世大学的人类研究伦理委员会的机构准则。 1.制备用于外科<ol><li>干净，以典型的方式准备了外科手术室。为了便于外科医生和灌注师之间的通信，心脏心肺机放置到患者的左侧，相对于该外科医生。 </li><li>麻醉诱导前60分钟 - 由5毫克咪达唑仑，30的口服给药前用药患者。 </li><li>让患者根据标准的指导方针，与直接动脉和麻醉师中心静脉压访问进行监控。 1.5毫克/千克丙泊酚，1 - - 2微克/千克芬太尼，和0.6毫克/公斤使用罗库溴铵0.5的初始静脉注射诱导麻醉。 </li><li>执行气管插管，并通过100的静脉内输注维持麻醉 - 150微克/ kg / min的丙泊酚，0.015 - 0.0381克/ kg / min的芬太尼和0.6 - 1.2微克/ kg / min的罗库溴铵需要。 </li><li>在仰卧位安装的病人，悬垂她/他在无菌的方式，使胸部，腹部，腹股沟免费手术视野。 </li></ol> 2.手术<ol><li>为了最小化由插管术野的拥挤，建立胸腔外的心肺旁路访问。 <ol><li>下面2厘米执行6厘米长的切口，并平行于右锁骨。准备右锁骨下动脉，从周围组织中释放它。得到的肝素/ kg的300 IU通过IV线。 </li><li>侧钳与库利Derra夹右锁骨下动脉。执行平行于其轴线的容器的10毫米长的动脉切口。 </li><li>使用运行6/0聚丙烯单丝缝线（ 例如，聚丙烯纺织纤维）缝8毫米涤纶移植物的端至端连接到动脉切口。插管用24星期五细长的单件动脉插管用于接枝rterial返回患者。 </li><li>在食管超声心动图的指导下，经皮导管插入右股静脉上的静脉引流导丝。 </li></ol></li><li>通过胸骨正中切口进入心脏。 <ol><li>纵向切开皮肤15厘米，开始胸骨上切迹下方1厘米。小心留在胸骨宽度的中间。 </li><li>看到了振荡锯胸骨。小心留在胸骨宽度的中间。 </li><li>切开心包在主动脉揭开了大规模扩张，曲折的右冠状动脉。 <ol><li>抓住与卡彭铁尔解剖钳心包。切断与梅岑鲍姆剪刀心包。继续切割心包到其反射线在使用电升主动脉。 </li></ol></li><li>启动体外循环和周解剖主动脉，从周围组织中解放出来，includ荷兰国际集团肺动脉，小心不要弄伤异常左冠状动脉。 <ol><li>轻推升主动脉用肺卷收器的左侧。抓住与卡彭铁尔解剖钳升主动脉后方软组织。 </li><li>从使用电周围组织分离升主动脉的后壁。尾部继续升主动脉后方。确保不损害升主动脉后方右肺动脉。 </li><li>抓住与卡彭铁尔解剖钳主肺动脉，轻轻将其推至左侧。从使用电灼主肺动脉分离升主动脉的左侧壁。 </li></ol></li><li>解剖与周围组织无主肺动脉。 <ol><li>拉向使用安装在一个夹具艾利斯花生纱布右侧升主动脉。 </li><li>直截了当地解剖主肺动脉后壁与安装在一个艾利斯夹持器的第二花生纱布。确保不损害主肺动脉背后的主力左冠状动脉。 </li><li>通过主肺动脉下剥离。轻轻打开剖分准备一个隧道血管循环的通道。 </li><li>打倒安装在卡彭铁尔解剖镊子血管循环，并将其放置在解剖的开放颌骨之间。关闭剥离的爪抓住容器循环。 </li><li>抓住升主动脉的外膜和拉被剥离持有的容器环环绕主肺动脉。 </li></ol></li><li>将左心室排气孔。 <ol><li>广场上有4/0聚​​丙烯单丝缝合右上肺静脉荷包。 </li><li>轻轻推动上腔静脉向左侧。 </li><li>请在与18刀片刀，右上肺静脉荷包中间一小截（参见材料李氏T）。 </li><li>轻轻扩张与LERICHE止血钳夹开幕。 </li><li>通过插入右上肺静脉和二尖瓣的通风口进入左心室卸载左心脏。与编织聚酯2/0结扎与聚涂层固定。 </li></ol></li><li>将逆行心脏停搏插管通过冠状窦。与编织聚酯2/0结扎用聚丁烯涂层固定。 </li><li>安装顺行停搏根。 <ol><li>广场上有4/0聚​​丙烯单丝缝合主，肺动脉荷包。 </li><li>请在与18刀片刀，主肺动脉荷包中间一小截（见材料清单）。 </li><li>轻轻扩张与LERICHE止血钳夹开幕。插入主肺动脉顺行停搏插管。与编织聚酯2/0结扎与聚涂层固定。 </li><li>放置PU在具有4/0聚​​丙烯单丝缝线的升主动脉RSE串。 </li><li>请在与18刀片刀，升主动脉荷包中间一小截。 </li><li>轻轻扩张与LERICHE止血钳夹开幕。 </li><li>插入一个顺行停搏插管入升主动脉。与编织聚酯2/0结扎与聚涂层固定。切断与梅岑鲍姆剪刀结扎。验证在主肺动脉及升主动脉顺行停搏插管的正确位置。 </li></ol></li></ol></li><li>准备打开主动脉。 <ol><li>夹闭主动脉远端为尽可能。通过主动脉和肺动脉同时交付顺行冷血停搏。 </li><li>取下主动脉和肺动脉插管并重复冷血停跳液逆行每20分钟。 </li><li>横切主动脉。 <ol><li>抓住作为cending左去除心脏停搏插管继开口的每一侧与卡彭解剖钳主动脉。放大有18刃刀开幕。 </li><li>完成与梅岑鲍姆剪刀主动脉横断。验证不存在于主动脉左窦主动脉内的左冠状动脉口的。 </li></ol></li><li>横切主肺动脉。 <ol><li>抓住左去除心脏停搏插管继开口的每一侧与卡彭解剖钳主肺动脉。放大有18刃刀开幕。 </li><li>完成与梅岑鲍姆剪刀主肺动脉横断。确认左冠状动脉口的存在，从向右的窦肺动脉110始发。 </li></ol></li><li>从肺动脉的右向窦1分离左冠状动脉口。 <ol><li>抓住近端肺主ARtery与卡彭铁尔解剖钳。使用梅岑鲍姆剪刀，从与肺根壁的慷慨周围补丁肺动脉右向窦1分离左冠状动脉口，小心不要伤害肺动脉瓣。 </li><li>调动主力左冠状动脉高达分叉。 </li></ol></li></ol></li><li>准备左冠状动脉开口重新植入。 <ol><li>抓住与卡彭铁尔解剖钳升主动脉近端。 </li><li>用直刀主动脉左窦2创建一个新口。离开主动脉根壁的10毫米左右缘向左窦2和主动脉的右冠状窦之间的连合的新口，以及朝向主动脉环。 </li><li>主要的左冠状动脉口端至端连接到新口在使用运行6/0聚丙烯单丝缝线的主动脉的左侧窦2。在D启动吻合主力左冠状动脉口的eepest点，并允许它上来就吻合的右侧。通过运行缝合线的左侧，以满足另一端完成吻合。 </li><li>为了拉动缝合时对组织舒缓紧张情绪，每次把主动脉和主左冠状动脉口在一起。 </li></ol></li><li>修复在肺动脉根缺陷。 <ol><li>使用非自体治疗心包补片。 </li><li>自体心包补片连接在使用一个运行6/0聚丙烯单丝缝线的肺动脉的右向窦1的最深点。 </li><li>第一运行起来左边，然后缝合线的右端到缺陷的中间高度在肺动脉的右向窦1。离开所述缝合线的两个端部在张力下。 </li></ol></li><li>重建大血管的连续性。 <ol><li>重新连接主动脉近端到其远端部分与端至端吻合术使用运行5/0聚丙烯单丝缝线。在最深点开始吻合，允许它上来就吻合的右侧。通过运行缝合线的左侧，以满足另一端完成吻合。 </li><li>去空气中的主动脉。取出主动脉阻断。启动复温病人。 </li><li>为了缩短缺血时间，进行近端和跳动的心脏肺动脉远端部分的重新连接。把泵吸盘到远端肺动脉以改善视力手术视野的。 </li><li>在正在运行的方式继续已被停在缺陷的中间高度肺动脉的右向窦1完成后及吻合的左侧方面的6/0聚丙烯缝线的左端。 </li><li>在正在运行的方式继续已被停在中间高度的6/0聚丙烯缝线的右端缺陷在肺动脉的右向窦1完成后和吻合的右方面。领带缝线的两端来完成连接。 </li></ol></li></ol>

<ol>
	<li>Dodge-Khatami, A., Mavroudis, C., Backer, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anomalous+origin+of+the+left+coronary+artery+from+the+pulmonary+artery:+collective+review+of+surgical+therapy.">Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy.</a> Ann. Thorac. Surg. 74 (3), 946-955 (2002).</li><li>Keith, J. 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+anomalous+origin+of+the+left+coronary+artery+from+the+pulmonary+artery.">The anomalous origin of the left coronary artery from the pulmonary artery.</a> Br. Heart J. 21 (2), 149-161 (1959).</li><li>Hauser, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Congenital+anomalies+of+the+coronary+arteries.">Congenital anomalies of the coronary arteries.</a> Heart. 91 (9), 1240-1245 (2005).</li><li>Wesselhoeft, H., Fawcett, J. S., Johnson, A. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anomalous+origin+of+the+left+coronary+artery+from+the+pulmonary+trunk.+Its+clinical+spectrum,+pathology,+and+pathophysiology,+based+on+a+review+of+140+cases+with+seven+further+cases.">Anomalous origin of the left coronary artery from the pulmonary trunk. Its clinical spectrum, pathology, and pathophysiology, based on a review of 140 cases with seven further cases.</a> Circulation. 38 (2), 403-425 (1968).</li><li>Edwards, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+direction+of+blood+flow+in+coronary+arteries+arising+from+the+pulmonary+trunk.">The direction of blood flow in coronary arteries arising from the pulmonary trunk.</a> Circulation. 29 (2), 163-166 (1964).</li><li>Agustsson, M. H., Gasul, B. M., Fell, H., Graettinger, J. S., Bicoff, J. P., Waterman, D. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anomalous+origin+of+the+left+coronary+artery+from+the+pulmonary+artery+diagnosis+and+treatment+of+infantile+and+adult+types.">Anomalous origin of the left coronary artery from the pulmonary artery diagnosis and treatment of infantile and adult types.</a> JAMA. 180 (1), 15-21 (1962).</li><li>Roberts, S. M., Banbury, T., Mehta, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+rare+case+of+anomalous+left+coronary+artery+from+the+pulmonary+artery+(Bland-White-Garland+Syndrome)+in+a+68-year-old+woman.">A rare case of anomalous left coronary artery from the pulmonary artery (Bland-White-Garland Syndrome) in a 68-year-old woman.</a> Semin. Cardiothorac. Vasc. Anesth. , (2016).</li><li>Yau, J. M., Singh, R., Halpern, E. J., Fischman, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anomalous+origin+of+the+left+coronary+artery+from+the+pulmonary+artery+in+adults:+a+comprehensive+review+of+151+adult+cases+and+a+new+diagnosis+in+a+53-year-old+woman.">Anomalous origin of the left coronary artery from the pulmonary artery in adults: a comprehensive review of 151 adult cases and a new diagnosis in a 53-year-old woman.</a> Clin. Cardiol. 34 (4), 204-210 (2011).</li><li>Michielon, G., 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=Anomalous+coronary+artery+origin+from+the+pulmonary+artery:+correlation+between+surgical+timing+and+left+ventricular+function+recovery.">Anomalous coronary artery origin from the pulmonary artery: correlation between surgical timing and left ventricular function recovery.</a> Ann. Thorac. Surg. 76 (2), 581-588 (2003).</li><li>Dodge-Khatami, A., Mavroudis, C., Backer, C. 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+Surgery+Nomenclature+and+Database+Project:+anomalies+of+the+coronary+arteries.">Congenital Heart Surgery Nomenclature and Database Project: anomalies of the coronary arteries.</a> Ann. Thorac. Surg. 69 (4 Suppl), S270-S297 (2000).</li><li>Talwar, S., Jha, A. J., Choudhary, S. K., Gupta, S. K., Airan, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Repair+of+anomalous+left+coronary+artery+from+pulmonary+artery+(ALCAPA)+beyond+infancy.">Repair of anomalous left coronary artery from pulmonary artery (ALCAPA) beyond infancy.</a> Heart Surg. Forum. 16 (4), E210-E215 (2013).</li><li>Toumpourleka, M., Belitsis, G., Alonso, R., Rubens, M., Moat, N., Gatzoulis, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Late+presentation+and+surgical+repair+of+ALCAPA.">Late presentation and surgical repair of ALCAPA.</a> Int. J. Cardiol. 186, 207-209 (2015).</li><li>Quah, J. X., 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=The+management+of+the+older+adult+patient+with+anomalous+left+coronary+artery+from+the+pulmonary+artery+syndrome:+a+presentation+of+two+cases+and+review+of+the+literature.">The management of the older adult patient with anomalous left coronary artery from the pulmonary artery syndrome: a presentation of two cases and review of the literature.</a> Congenit. Heart Dis. 9 (6), E185-E194 (2014).</li><li>Kottayil, B. P., 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=Anomalous+origin+of+left+coronary+artery+from+pulmonary+artery+in+older+children+and+adults:+direct+aortic+implantation.">Anomalous origin of left coronary artery from pulmonary artery in older children and adults: direct aortic implantation.</a> Ann. Thorac. Surg. 91 (2), 549-553 (2011).</li><li>Rajbanshi, B. G., Burkhart, H. M., Schaff, H. V., Daly, R. C., Phillips, S. D., Dearani, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+strategies+for+anomalous+origin+of+coronary+artery+from+pulmonary+artery+in+adults.">Surgical strategies for anomalous origin of coronary artery from pulmonary artery in adults.</a> J. Thorac. Cardiovasc. Surg. 148 (1), 220-224 (2014).</li><li>Neumann, A., 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+results+after+repair+of+anomalous+origin+of+left+coronary+artery+from+the+pulmonary+artery:+Takeuchi+repair+versus+coronary+transfer.">Long-term results after repair of anomalous origin of left coronary artery from the pulmonary artery: Takeuchi repair versus coronary transfer.</a> Eur. J. Cardio-Thorac. Surg. , (2016).</li><li>Pe&#241;a, E., Nguyen, E. T., Merchant, N., Dennie, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ALCAPA+syndrome:+not+just+a+pediatric+disease.">ALCAPA syndrome: not just a pediatric disease.</a> Radiographics. 29 (2), 553-565 (2009).</li></ol>

作者什么都没有透露。

这个协议描述了ALCAPA的直接再植入到主动脉与主左冠状动脉从根据道奇-哈塔米分类10中的肺动脉的右向窦起源成年患者的详细技术。心肌保护策略和肺动脉重建都清楚地证明。这个技术的主要关键步骤是通过左冠状动脉的慷慨动员表示实现无张力的吻合术。 长时间去饱和冠状动脉灌注容忍到成年期在少数个人。谁生存本到成年的临床表现的光谱，从没有症?...

从肺动脉（ALCAPA）左冠状动脉异常起源是一种罕见的先天性异常通常被视为分离的病变1。 ALCAPA的发生率估计为1 300000活产，0.24％和先天性心脏病2,3的0.46％之间，包括这是小儿心肌缺血和梗死的最常见的原因之一，如果不及时治疗，导致死亡率生活4的第一年90％。只有10 - 15％的婴儿存活由于大主导右冠状动脉（RCA）提供广泛的intercoronary络4的迅猛发展到成年。在新生儿期，高肺血管阻力和所得肺动脉（PA）的压力下确保顺行流从PA保持到异常左冠状动脉。由于pulmonarÿ血管阻力逐渐减小，顺行流向左冠状动脉降低。这最终导致流动的逆转，和左到右分流到PA，从而导致"冠状动脉偷5"。因此，左心室（LV）心肌灌注取决于intercoronary络从RCA 5,6。 冠状偷现象和逆行左侧冠状动脉血流提供慢性心内膜下缺血，这可能导致左心功能不全，缺血性二尖瓣反流，和由急性心肌缺血7沉淀恶性室性心律失常的基板。在成人患者的子集，在介绍的平均年龄为41岁，性别分布朝向女性患者的移位（女到男比:2:1）8。在此患者群体中，14％是无症状; 66％用本心绞痛，呼吸困难，心悸，或疲劳的症状;和现在有危及生命的症状，包括室性心律失常，晕厥和心源性猝死8 17％。危及生命的表现，平均年龄为33岁，心脏性猝死31岁8。因此，手术矫正高度只要作出诊断建议，不论年龄或intercoronary抵押1,9的程度。 根据异常左冠状动脉起源的ALCAPA进入主动脉的直接再植入是多种生理声音修复技术重建双冠状动脉灌注系统。最常见地，从ALCAPA右侧肺窦（PA的窦1），其面向主动脉窦其中主左冠状动脉通常起源（主动脉窦2）10 &lt;起飞/ SUP&gt;。这冠状动脉解剖是最适合于直接再注入技术。本报告的目的是描述，详细，对于成人患者在ALCAPA左冠状动脉的直接再植入技术。后面直接再注入的理由是优势-双冠状动脉的生理重建灌注它提供了一个在异常左冠状动脉与冠状动脉旁路移植11，12，13结合的结扎。

<table><tbody><tr><td colspan="4">&lt;strong&gt;Heart surgery infrastructure&lt;/strong&gt;</td></tr><tr><td>Heart Lung Machine</td><td>Stockert</td><td>SIII</td><td></td></tr><tr><td>EOPA 24Fr. arterial cannula</td><td>Medtronic</td><td>77624</td><td></td></tr><tr><td>Quickdraw 25Fr. femoral venous cannula</td><td>Edwards</td><td>QD25</td><td></td></tr><tr><td>LV vent catheter 17Fr.</td><td>Edwards</td><td>E061</td><td></td></tr><tr><td>Antegrade 9Fr. cardioplegia cannula</td><td>Edwards</td><td>AR012V</td><td></td></tr><tr><td>Retrograde 14Fr. cardioplegia cannula&amp;nbsp;</td><td>Edwards</td><td>NPC014&amp;nbsp;</td><td></td></tr><tr><td>Electrocautery</td><td>Covidien</td><td>Force FX</td><td></td></tr><tr><td colspan="4">&lt;strong&gt;Sutures&lt;/strong&gt;</td></tr><tr><td>Polypropylene 4/0</td><td>Ethicon</td><td>8871H</td><td></td></tr><tr><td>Polypropylene 5/0</td><td>Ethicon</td><td>8870H</td><td></td></tr><tr><td>Polypropylene 6/0</td><td>Ethicon</td><td>EH7400H</td><td></td></tr><tr><td>Braided polyesther 2/0 ligature with polybutylate coating&amp;nbsp;</td><td>Ethicon</td><td>X305H</td><td></td></tr><tr><td>Intergard dacron graft 8 mm</td><td>Maquet</td><td>IGW0008-30</td><td></td></tr><tr><td>Micro knife Sharpoint&amp;nbsp;</td><td>TYCO Healthcare PTY&amp;nbsp;</td><td>78-6900</td><td></td></tr><tr><td colspan="4">&lt;strong&gt;Drugs&lt;/strong&gt;</td></tr><tr><td>Midazolam</td><td>Roche Pharma</td><td>N05CD08</td><td></td></tr><tr><td>Rocuronium</td><td>&lt;a href=&quot;https://www.compendium.ch/comp/mnr/22695/de&quot;&gt;MSD Merck Sharp &amp;amp; Dohme&amp;nbsp;&lt;/a&gt;</td><td>M03AC09</td><td></td></tr><tr><td>Propofol</td><td>Fresenius Kabi</td><td>N01AX10</td><td></td></tr><tr><td>Fentanil</td><td>Actavis</td><td>N01AH01</td><td></td></tr><tr><td colspan="4">&lt;strong&gt;Instruments&lt;/strong&gt;</td></tr><tr><td>Cooley Derra anastomosis clamp</td><td>Delacroix-Chevalier</td><td>DC40810-16</td><td></td></tr><tr><td>Cooley vascular clamp</td><td>Delacroix-Chevalier</td><td>DC40810-16</td><td></td></tr><tr><td>Dissection forceps Carpentier</td><td>Delacroix-Chevalier</td><td>DC13110-28&amp;nbsp;</td><td></td></tr><tr><td>Scissors Metzenbaum</td><td>Delacroix-Chevalier</td><td>B351751</td><td></td></tr><tr><td>Needle holder Ryder</td><td>Delacroix-Chevalier</td><td>DC51130-20&amp;nbsp;</td><td></td></tr><tr><td>Dissection forceps DeBakey</td><td>Delacroix-Chevalier</td><td>DC12000-21&amp;nbsp;</td><td></td></tr><tr><td>Micro needle holder Jacobson</td><td>Delacroix-Chevalier</td><td>DC50002-21&amp;nbsp;</td><td></td></tr><tr><td>Micro scisors Jacobson</td><td>Delacroix-Chevalier</td><td>DC20057-21&amp;nbsp;</td><td></td></tr><tr><td>Lung retractor</td><td>Delacroix-Chevalier</td><td>B803990</td><td></td></tr><tr><td>Allis clamp</td><td>Delacroix-Chevalier</td><td>DC45907-25&amp;nbsp;</td><td></td></tr><tr><td>O&amp;rsquo;Shaugnessy Dissector</td><td>Delacroix-Chevalier</td><td>B60650</td><td></td></tr><tr><td>Vessel loop</td><td>Medline</td><td>VLMINY</td><td></td></tr><tr><td>18 blade knife</td><td>Delacroix-Chevalier</td><td>B130180</td><td></td></tr><tr><td>Leriche haemostatic clamp</td><td>Delacroix-Chevalier</td><td>B86555</td><td></td></tr></tbody></table>

direct re-implantation of left coronary artery into the aorta in adults with anomalous origin of left coronary artery from the pulmonary artery (alcapa)

从肺动脉（ALCAPA）左冠状动脉起源异常是一种罕见的先天性异常是小儿心肌缺血和梗死的主要原因之一。如果不及时治疗，它会导致死亡率在生命的第一年90％。在谁存活到成年患者，冠状动脉偷窃现象，逆行左侧冠状动脉流量为慢性心内膜下缺血，这可能会导致左心功能不全，缺血性二尖瓣关闭不全，恶性室性心律失常和心源性猝死的基材。危及生命的表现，平均年龄为33岁，心脏性猝死31岁。因此，手术矫正高度一旦作出诊断建议，不论年龄。在成人型ALCAPA从肺动脉的右向窦起源的ALCAPA到主动脉的直接再注入是多种生理声音修复技术吨Ø重新建立双冠脉灌注系统和建议。这个协议描述成人型ALCAPA的直接再注入技术进入主动脉。

<html>介绍患者是一名48岁的女子与近期心绞痛加拿大心血管学会（CCS）毕业生III和偶尔的心悸发作呈现。她报告了三名波澜不惊怀孕。中度吸烟是主要的心血管危险因素。经胸超声心动图显示一个中度受损（45％）左室射血分数和无二尖瓣关闭不全。然后进行一个冠状动脉造影。它表明没有从主动脉引起的左冠状动脉主干的。右?...

Watch this Scientific Journal Video about Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA at JoVE

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA

ALCAPA的手术矫正强烈建议，无论年龄或intercoronary抵押的程度。该协议提出了成年型ALCAPA的直接再植入到主动脉重新建立双冠状动脉灌注的技术。只要可行，直接再注入优选其它外科手术校正技术。

左冠状动脉直接再注入与从肺动脉左冠状动脉起源异常成人主动脉（ALCAPA）

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly which is one of leading causes of myocardial ...

direct-re-implantation-left-coronary-artery-into-aorta-adults-with

Universidad de Cartagena UDEC

Research

JoVE Journal

Medicine

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)

18.5K 次观看.  University of Zurich.  ALCAPA的手术矫正强烈建议，无论年龄或intercoronary抵押的程度。该协议提出了成年型ALCAPA的直接再植入到主动脉重新建立双冠状动脉灌注的技术。只要可行，直接再注入优选其它外科手术校正技术。 

视频: Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA

A Murine Model of Myocardial Ischemia-reperfusion Injury through Ligation of the Left Anterior Descending Artery

Acute or chronic myocardial infarction (MI) are cardiovascular events resulting in high morbidity and mortality. Establishing the pathological mechanisms at work during MI and developing effective therapeutic approaches requires methodology to reproducibly simulate the clinical incidence and reflect the pathophysiological changes associated with MI. Here, we describe a surgical method to induce MI in mouse models that can be used for short-term ischemia-reperfusion (I/R) injury as well as permanent ligation. The major advantage of this method is to facilitate location of the left anterior descending artery (LAD) to allow for accurate ligation of this artery to induce ischemia in the left ventricle of the mouse heart. Accurate positioning of the ligature on the LAD increases reproducibility of infarct size and thus produces more reliable results. Greater precision in placement of the ligature will improve the standard surgical approaches to simulate MI in mice, thus reducing the number of experimental animals necessary for statistically relevant studies and improving our understanding of the mechanisms producing cardiac dysfunction following MI. This mouse model of MI is also useful for the preclinical testing of treatments targeting myocardial damage following MI.

We introduce a surgical method to induce experimental ischemia/reperfusion (I/R) injury to simulate myocardial infarction (MI) in mouse models that allows for more clarity in positioning of the ligation on the left anterior descending artery (LAD) to increase the reproducibility of MI experiments in mice.

心肌缺血再灌注损伤的通过左前降支结扎小鼠模型

Acute or chronic myocardial infarction (MI) are cardiovascular events resulting in high morbidity and mortality. Establishing the pathological mechanisms ...

科研

医学

Permanent Ligation of the Left Anterior Descending Coronary Artery in Mice: A Model of Post-myocardial Infarction Remodelling and Heart Failure

Heart failure is a syndrome in which the heart fails to pump blood at a rate commensurate with cellular oxygen requirements at rest or during stress. It is characterized by fluid retention, shortness of breath, and fatigue, in particular on exertion. Heart failure is a growing public health problem, the leading cause of hospitalization, and a major cause of mortality. Ischemic heart disease is the main cause of heart failure.
Ventricular remodelling refers to changes in structure, size, and shape of the left ventricle. This architectural remodelling of the left ventricle is induced by injury (e.g., myocardial infarction), by pressure overload (e.g., systemic arterial hypertension or aortic stenosis), or by volume overload. Since ventricular remodelling affects wall stress, it has a profound impact on cardiac function and on the development of heart failure. A model of permanent ligation of the left anterior descending coronary artery in mice is used to investigate ventricular remodelling and cardiac function post-myocardial infarction. This model is fundamentally different in terms of objectives and pathophysiological relevance compared to the model of transient ligation of the left anterior descending coronary artery. In this latter model of ischemia/reperfusion injury, the initial extent of the infarct may be modulated by factors that affect myocardial salvage following reperfusion. In contrast, the infarct area at 24 hr after permanent ligation of the left anterior descending coronary artery is fixed. Cardiac function in this model will be affected by 1) the process of infarct expansion, infarct healing, and scar formation; and 2) the concomitant development of left ventricular dilatation, cardiac hypertrophy, and ventricular remodelling.
Besides the model of permanent ligation of the left anterior descending coronary artery, the technique of invasive hemodynamic measurements in mice is presented in detail.

Heart failure is the leading cause of hospitalization and a major cause of mortality. A model of permanent ligation of the left anterior descending coronary artery in mice is applied to investigate ventricular remodelling and cardiac dysfunction post-myocardial infarction. The technique of invasive hemodynamic measurements in mice is presented.

左冠状动脉前降支的小鼠结扎:对心肌梗死后重塑和心衰模型

Heart failure is a syndrome in which the heart fails to pump blood at a rate commensurate with cellular oxygen requirements at rest or during stress. It ...

Transplantation of a 3D Bioprinted Patch in a Murine Model of Myocardial Infarction

Testing regenerative properties of 3D bioprinted cardiac patches in vivo using murine models of heart failure via permanent left anterior descending (LAD) ligation is a challenging procedure and has a high mortality rate due to its nature. We developed a method to consistently transplant bioprinted patches of cells and hydrogels onto the epicardium of an infarcted mouse heart to test their regenerative properties in a robust and feasible way. First, a deeply anesthetized mouse is carefully intubated and ventilated. Following left lateral thoracotomy (surgical opening of the chest), the exposed LAD is permanently ligated and the bioprinted patch transplanted onto the epicardium. The mouse quickly recovers from the procedure after chest closure. The advantages of this robust and quick approach include a predicted 28-day mortality rate of up to 30% (lower than the 44% reported by other studies using a similar model of permanent LAD ligation in mice). Moreover, the approach described in this protocol is versatile and could be adapted to test bioprinted patches using different cell types or hydrogels where high numbers of animals are needed to optimally power studies. Overall, we present this as an advantageous approach which may change preclinical testing in future studies for the field of cardiac regeneration and tissue engineering.

This protocol aims to transplant a 3D bioprinted patch onto the epicardium of infarcted mice modeling heart failure. It includes details regarding anesthesia, the surgical chest opening, permanent ligation of the left anterior descending (LAD) coronary artery and application of a bioprinted patch onto the infarcted area of the heart.

心肌梗塞穆林模型中的 3D 生物打印贴片移植

Testing regenerative properties of 3D bioprinted cardiac patches in vivo using murine models of heart failure via permanent left anterior descending (LAD) ...

生物工程

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

In patients with small aortic roots who need an aortic valve replacement with biological valve substitutes, the implantation of the stented pericardial valve might not meet the functional needs. The implantation of a too-small stented pericardial valve, leading to an effective orifice area indexed to a body surface area less than 0.85 cm2/m2, is regarded as prosthesis-patient mismatch (PPM). A PPM negatively affects the regression of left ventricular hypertrophy and thus the normalization of left ventricular function and the alleviation of symptoms. Persistent left ventricular hypertrophy is associated with an increased risk of arrhythmias and sudden cardiac death. In the case of predictable PPM, there are three options: 1) accept the PPM resulting from the implantation of a stented pericardial valve when comorbidities of the patient forbid the more technically demanding operative technique of implanting a larger prosthesis, 2) enlarge the aortic root to accommodate a larger stented valve substitute, or 3) implant a stentless biological valve or a homograft. Compared to classical aortic valve replacement with stented pericardial valves, the full-root implantation of stentless aortic xenografts offers the possibility of implanting a 3-4 mm larger valve in a given patient, thus allowing significant reduction in transvalvular gradients. However, a number of cardiac surgeons are reluctant to transform a classical aortic valve replacement with stented pericardial valves into the more technically challenging full-root implantation of stentless aortic xenografts. Given the potential hemodynamic advantages of stentless aortic xenografts, we have adopted full-root implantation to avoid PPM in patients with small aortic roots necessitating an aortic valve replacement. Here, we describe in detail a technique for the full-root implantation of stentless aortic xenografts, with emphasis on the management of the proximal suture line and coronary anastomoses. Limitations of this technique and alternative options are discussed.

Full-root aortic valve replacement by stentless aortic xenograft is a viable option in patients with small aortic roots. We describe, a technique for the full-root implantation of stentless aortic xenografts, with emphasis on the management of the proximal suture line and coronary anastomoses, and discuss its limitations and alternative options.

全根主动脉瓣置换主动脉瓣狭窄主动脉异种移植患者小主动脉根

In patients with small aortic roots who need an aortic valve replacement with biological valve substitutes, the implantation of the stented pericardial ...

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Despite the obvious advantages of the preservation of a normal aortic valve during aortic root replacement, the complexity of valve sparing procedures prevents a number of cardiac surgeons from incorporating them into their practice. The aim of this protocol is to describe a simplified and user-friendly technique of an aortic valve-sparing root replacement (VSRR) procedure by re-implantation of the aortic valve. Proper selection of patients and limitations of the technique are discussed.
In 54 consecutive patients, normal appearing aortic valves were re-implanted in a commercially available polyester prosthesis with pre-shaped sinuses by a simplified and standardized technique. Placement of the first row of the proximal suture line, choice of the prosthesis size, and adjustment of the height of the commissures of the patient to the fixed height of the sinus portion of the prosthesis were slightly modified from the reference techniques with the aim of increasing its feasibility for use by other cardiac surgeons. Early mortality and morbidity as well as 5-year survival, freedom from aortic valve reoperation, and freedom from recurrent moderate regurgitation were collected in all patients.
Thirty-day mortality, re-sternotomy for bleeding, re-sternotomy for mediastinitis, and the incidence of stroke were very low, 1.8% for each (1 of 54). No patient required permanent pace-maker implantation. At 5 years, survival, freedom from aortic valve reoperation, and freedom from recurrent moderate regurgitation were 97.5%, 95.2%, and 91.6%, respectively.
Mid-term results of our standardized technique of re-implantation of the aortic valve for valve-sparing aortic root replacement are very good and compare with more complex techniques reported by experienced surgeons. By following the present protocol of the standardized re-implantation technique, a greater number of cardiac surgeons can perform this procedure with comparable good results.

Valve-sparing aortic root replacement has the advantage of preserving the patient&#39;s own aortic valve. The complexity of the reported techniques to date restricts their use to a limited number of cardiac surgeons. This protocol describes step-by-step a standardized technique reproducible by a greater number of cardiac surgeons.

主动脉瓣重置术治疗瓣膜备用主动脉根置换的规范化技术

Despite the obvious advantages of the preservation of a normal aortic valve during aortic root replacement, the complexity of valve sparing procedures ...

An Immunological Model for Heterotopic Heart and Cardiac Muscle Cell Transplantation in Rats

Heterotopic heart transplantation in rats has been a commonly used model for diverse immunological studies for more than 50 years. Several modifications have been reported since the first description in 1964. After 30 years of performing heterotopic heart transplantation in rats, we have developed a simplified surgical approach, which can be easily taught and performed without further surgical training or background.
After dissection of the ascending aorta and the pulmonary artery and ligation of superior and inferior caval and pulmonary veins, the donor heart is harvested and subsequently perfused with ice-cold saline solution supplemented with heparin. After clamping and incising the recipient abdominal vessels, the donor ascending aorta and pulmonary artery are anastomosed to the recipient abdominal aorta and inferior vena cava, respectively, using continuous running sutures.
Depending on different donor-recipient combinations, this model allows analyses of either acute or chronic rejection of allografts. The immunological significance of this model is further enhanced by a novel approach of in-ear injection of vital cardiac muscle cells and subsequent analysis of draining cervical lymphatic tissue.

We describe a model of heterotopic abdominal heart transplantation in rats, implying modifications of current strategies, which lead to a simplified surgical approach. Additionally, we describe a novel rejection model by in-ear injection of vital cardiac muscle cells, allowing further transplant immunological analyses in rats.

大鼠异位心脏和心肌细胞移植的免疫模型

Heterotopic heart transplantation in rats has been a commonly used model for diverse immunological studies for more than 50 years. Several modifications ...

免疫与感染

A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation

Fifty-years following the first successful report, cardiac transplantation remains the gold-standard treatment for eligible patients with advanced heart failure. Multiple small-animal models of heart transplantation have been used to study the acute and long-term effects of novel therapies. However, few are tested and demonstrated success in clinical trials. It is of critical importance to evaluate new therapies in a clinically relevant large-animal model for efficient and reliable translation of basic studies&#39;&#160;findings. Here, we describe a pre-clinical large-animal (porcine) model of orthotopic heart transplantation that has been firmly established and previously used to investigate novel cardioprotective strategies. This procedure focuses on acute ischemia-reperfusion injury and is a reliable method to investigate novel interventions which have been tested and validated in smaller experimental models, such as the murine model. We demonstrate its usefulness in assessing cardiac performance during the early post-transplantation period and other potential possibilities enabled by the model.

Here, we describe a pre-clinical large-animal (porcine) model of orthotopic heart transplantation that has been firmly established and utilized to investigate novel cardioprotective strategies.

正交心脏移植的临床前猪模型

Fifty-years following the first successful report, cardiac transplantation remains the gold-standard treatment for eligible patients with advanced heart ...

Left Lung Orthotopic Transplantation in a Juvenile Porcine Model for ESLP

Lung transplantation is the gold-standard treatment for end-stage lung disease, with over 4,600 lung transplantations performed worldwide annually. However, lung transplantation is limited by a shortage of available donor organs. As such, there is high waitlist mortality. Ex situ lung perfusion (ESLP) has increased donor lung utilization rates in some centers by 15%-20%. ESLP has been applied as a method to assess and recondition marginal donor lungs and has demonstrated acceptable short- and long-term outcomes following transplantation of extended criteria donor (ECD) lungs. Large animal (in vivo) transplantation models are required to validate ongoing in vitro research findings. Anatomic and physiologic differences between humans and pigs pose significant technical and anesthetic challenges. An easily reproducible transplant model would permit the&#160;in vivo&#160;validation of current ESLP strategies and the preclinical evaluation of various interventions designed to improve donor lung function. This protocol describes a porcine model of orthotopic left lung allotransplantation. This includes anesthetic and surgical techniques, a customized surgical checklist, troubleshooting, modifications, and the benefits and limitations of the approach.

This protocol describes a juvenile porcine model of orthotopic left lung allotransplantation designed for use with ESLP research. Focus is made on anesthetic and surgical techniques, as well as critical steps and troubleshooting.

ESLP幼猪模型中的左肺原位移植

Lung transplantation is the gold-standard treatment for end-stage lung disease, with over 4,600 lung transplantations performed worldwide annually. ...

Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control

Coronary heart disease is the leading cause of death globally. Complete cessation of blood flow in coronary arteries causes ST-segment elevation myocardial infarction (STEMI), resulting in cardiogenic shock and fatal arrhythmia, which are associated with high mortality. Primary coronary intervention (PCI) for recanalizing the coronary artery significantly improves the outcomes of STEMI, but advancements made in shortening the door-to-balloon time have failed to reduce in-hospital mortality, suggesting that additional therapeutic strategies are required. Left anterior descending coronary artery (LAD) ligation in rats is an animal model for acute myocardial IR research that is comparable to the clinical scenario in which rapid coronary recanalization through PCI is used for STEMI; however, PCI-induced STEMI is a technically challenging and complicated operation associated with high mortality and great variation in infarction size. We identified the ideal position for LAD ligation, created a gadget to control a snare loop, and supported a modified surgical maneuver, thereby reducing tissue damage, to establish a reliable and reproducible acute myocardial ischemia-reperfusion (IR) research protocol for rats. This is a non-survival surgery. We also propose a method for validating the quality of study results, which is a critical step for determining the accuracy of subsequent biochemical analyses.

Herein, we present a protocol focusing on the quality control of the left anterior descending coronary artery ligation by technically modifying the traditional procedure in rats for acute myocardial ischemia-reperfusion research.

用于缺血再灌注研究的左前降冠状动脉结扎术:通过技术修改和质量控制改进模型

Coronary heart disease is the leading cause of death globally. Complete cessation of blood flow in coronary arteries causes ST-segment elevation ...

辅助外泌体治疗：促进 CABG 手术后的心肌恢复

Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft

Chronic myocardial ischemia resulting from progressive coronary artery stenosis leads to hibernating myocardium (HIB), defined as myocardium that adapts to reduced oxygen availability by reducing metabolic activity, thereby preventing irreversible cardiomyocyte injury and infarction. This is distinct from myocardial infarction, as HIB has the potential for recovery with revascularization. Patients with significant coronary artery disease (CAD) experience chronic ischemia, which puts them at risk for heart failure and sudden death. The standard surgical intervention for severe CAD is coronary artery bypass graft surgery (CABG), but it has been shown to be an imperfect therapy, yet no adjunctive therapies exist to recover myocytes adapted to chronic ischemia. To address this gap, a surgical model of HIB using porcine that is amenable to CABG and mimics the clinical scenario was used. The model involves two surgeries. The first operation involves implanting a 1.5 mm rigid constrictor on the left anterior descending (LAD) artery. As the animal grows, the constrictor gradually causes significant stenosis resulting in reduced regional systolic function. Once the stenosis reaches 80%, the myocardial flow and function are impaired, creating HIB. An off-pump CABG is then performed with the left internal mammary artery (LIMA) to revascularize the ischemic region. The animal recovers for one month to allow for optimal myocardial improvement prior to sacrifice. This allows for physiologic and tissue studies of different treatment groups. This animal model demonstrates that cardiac function remains impaired despite CABG, suggesting the need for novel adjunctive interventions. In this study, a collagen patch embedded with mesenchymal stem cell (MSC)-derived exosomes was developed, which can be surgically applied to the epicardial surface distal to LIMA anastomosis. The material conforms to the epicardium, is absorbable, and provides the scaffold for the sustained release of signaling factors. This regenerative therapy can stimulate myocardial recovery that does not respond to revascularization alone. This model translates to the clinical arena by providing means of physiological and mechanistic explorations regarding recovery in HIB.

作者聚焦：增强冠状动脉血运重建

This study presents a surgical porcine model of chronic myocardial ischemia due to progressive coronary artery stenosis, resulting in impaired cardiac function without infarction. Following ischemia, animals undergo off-pump coronary artery bypass graft with epicardial placement of stem cells-derived exosomes-laden collagen patch. This adjunctive therapy improves myocardial function and recovery.

外泌体胶原贴片和体外循环冠状动脉旁路移植术治疗慢性心肌缺血的外科猪模型

Chronic myocardial ischemia resulting from progressive coronary artery stenosis leads to hibernating myocardium (HIB), defined as myocardium that adapts ...