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Applications of The Visible Heart for cardiac valve repair and replacement devices.

机译：可见心脏在心脏瓣膜修复和置换设备中的应用。

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摘要

The Visible HeartRTM methodologies utilize an isolated heart apparatus for the investigation of large mammalian hearts, such as human, swine, canine, or sheep. In vitro, the hearts are perfused with a clear buffer, allowing for real-time, intracardiac imaging of a beating heart. These methodologies have been developed, enhanced, and employed at the University of Minnesota for over ten years, with the general methods having been previously described. The primary focus of earlier studies was on lead implantation and assessments of functional anatomy. My work was to investigate how this unique experimental setup could be optimized to better understand valve function.;In addition, I designed subsequent experiments as a means to better design products for the repair and/or replacement of pathological cardiac valves. In order to achieve my desired thesis goal, it was paramount to gain a thorough understanding of cardiac anatomy. As such, a review of the four main cardiac valves is provided in Chapter 1. The goal of this chapter is to familiarize the reader with current nomenclature of the cardiac valves as well as the important anatomical features associated with each.;In Chapter 2, the capabilities and limitations of the Visible Heart RTM, in its current state, are discussed in context of the design process for cardiac valve repair and/or replacement products. To this end, the following areas are identified as applications for the Visible Heart RTM that can aid valve repair and replacement: (1) Functional Anatomy, (2) Device Delivery and Device/Tissue Interactions, (3) Chronic Model Development and Acute Valve Assessment, (4) Acute Assessment of Surgical Repairs, (5) Pre-clinical Human Heart In Vitro Testing, and (6) Early Prototype Testing for Designers.;Chapters 3-7 provide detailed examples of employing Visible Heart RTM methodologies as they relate to each of these areas. The functional anatomy affecting two percutaneous mitral valve repair procedures is discussed in Chapters 3 and 4. Chapter 5 investigates the delivery and device/tissue interactions of a transcatheter pulmonary valve. A chronic animal model of dilated cardiomyopathy was developed in which mitral regurgitation due to ventricular remodeling was observed after several weeks of pacing; this model is now available within the Visible HeartRTM for acute assessment of devices seeking to treat this valve pathology (Chapter 6). Chapter 7 then looks at the acute assessment of the "edge-to-edge" mitral valve repair technique following induced P2 prolapse and provides control data for any device seeking to mimic this repair procedure percutaneously. Perfusion-fixed human specimens were utilized in Chapters 3 and 4, and a reanimated human heart was utilized for in vitro testing in Chapter 5. Finally, many early prototypes have been studied and tested in our laboratories using the Visible Heart RTM methods, but it is beyond the scope of this thesis to discuss the details of these studies.;This work has advanced our understanding of the capabilities and limitations of a large mammalian, isolated heart preparation as it relates to the design processes for valve replacement and/or repair devices. This work is not an exhaustive list, but rather the beginning of many potential studies that will now be better designed based upon the capabilities and limitations I have identified. Additionally, the Visible HeartRTM is a dynamic system that will continue to advance and add capabilities, which will only serve to make it more important in the field of valve assessment.
机译：Visible HeartRTM方法利用隔离的心脏设备来研究大型哺乳动物心脏，例如人，猪，犬或绵羊。在体外，用透明缓冲液灌注心脏，以便对跳动的心脏进行实时的心内成像。这些方法已经在明尼苏达大学开发，增强和使用了十多年，其通用方法已在前面进行了描述。早期研究的主要重点是铅植入和功能解剖学评估。我的工作是研究如何优化这种独特的实验设置以更好地理解瓣膜功能。此外，我设计了后续实验，以更好地设计用于修复和/或更换病理性心脏瓣膜的产品。为了达到我期望的论文目标，对心脏解剖学有透彻的了解是至关重要的。因此，在第1章中对四个主要的心脏瓣膜进行了回顾。本章的目的是使读者熟悉心脏瓣膜的当前命名法以及与之相关的重要解剖特征。在目前的状态下，在心脏瓣膜修复和/或替换产品的设计过程中讨论了Visible Heart RTM的功能和局限性。为此，Visible Heart RTM的以下领域被确定为可帮助瓣膜修复和更换的应用：（1）功能解剖，（2）设备递送和设备/组织相互作用，（3）慢性模型开发和急性瓣膜评估，（4）外科手术的急性评估，（5）临床前人类心脏体外测试和（6）设计人员的早期原型测试。；第3-7章提供了使用Visible Heart RTM方法的详细示例到每个领域。在第3章和第4章中讨论了影响两种经皮二尖瓣修复程序的功能解剖。第5章研究了经导管肺动脉瓣的递送以及装置/组织之间的相互作用。建立了扩张型心肌病的慢性动物模型，其中在起搏几周后观察到由于心室重构引起的二尖瓣关闭不全。该模型现在在Visible HeartRTM中可用，用于对试图治疗这种瓣膜病变的设备进行急性评估（第6章）。然后，第7章研究了诱发的P2脱垂后对“边缘到边缘”二尖瓣修复技术的急性评估，并提供了寻求通过皮肤模拟该修复程序的任何设备的控制数据。在第3章和第4章中使用了灌注固定的人类标本，在第5章中使用了经过修复的人类心脏进行体外测试。最后，我们在实验室中使用Visible Heart RTM方法对许多早期原型进行了研究和测试，但是讨论这些研究的详细信息超出了本文的范围。；这项工作使我们对大型哺乳动物离体心脏准备的功能和局限性有了更深入的了解，因为它与瓣膜置换和/或修复装置的设计过程有关。这项工作不是详尽的清单，而是许多潜在研究的开始，现在将根据我已经确定的能力和局限性更好地设计这些研究。此外，Visible HeartRTM是一个动态系统，将继续发展并增加功能，这只会使其在瓣膜评估领域变得更加重要。

著录项

  • 作者

    Quill, Jason Lloren.;

  • 作者单位

    University of Minnesota.;

  • 授予单位 University of Minnesota.;
  • 学科 Engineering Biomedical.
  • 学位 Ph.D.
  • 年度 2009
  • 页码 274 p.
  • 总页数 274
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 生物医学工程;
  • 关键词

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