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目的:寻求简单、经济的方法建立组织工程心脏瓣膜体内实验动物模型。方法:体质量20~30 kg成年绵羊9只,接受非体外循环下去细胞猪主动脉带瓣管道植入胸部降主动脉手术,并用自行研制的闭式主动脉瓣剪剪切造成自体主动脉瓣关闭不全。术中记录血压变化,术后观察植入瓣膜启闭功能,6个月后测量管壁厚度、管腔大小以及病理形态学改变。结果:术中自体主动脉瓣关闭不全后,收缩压升高,带瓣管道近心端舒张压比自体主动脉瓣关闭不全前显著降低,自体主动脉瓣脉压差明显增大,植入去细胞猪主动脉带瓣管道瓣膜两侧舒张期压力阶差增大。手术后2个月磁共振检查显示植入的瓣膜启闭功能良好,B超显示自体主动脉瓣中-重度关闭不全。术后6个月切取带瓣管道见:带瓣管道无扩张、血栓形成、瓣膜粘连、增厚、狭窄及关闭不全等改变,带瓣管道管壁厚度和管腔大小与术前无明显变化,但管壁明显僵硬,有局限性钙化现象。超微结构及病理学检查显示瓣膜和管道内表面均已内皮化,瓣叶和管道均有间质细胞存在,散在少许炎性细胞浸润。结论:通过非体外循环下将去细胞猪主动脉带瓣管道植入绵羊胸部降主动脉,并用自行研制的闭式主动脉瓣剪剪切使自体主动脉瓣关闭不全建立的组织工程心脏瓣膜体内研究动物模型,具有创伤小、术后生存率高、对实验干扰因素少以及节省人力、物力和财力等优点。
OBJECTIVE: To find a simple and economical method to establish a tissue engineering heart valve in vivo experimental animal model. Methods: Nine adult sheep aged 20-30 kg were enrolled in this study. The aorta of thoracic aorta underwent implantation of aorta flap with off-pump aorta under cardiopulmonary bypass. The aortic valve was excised by closed aortic valve pruning Closing incomplete. Intraoperative blood pressure changes recorded after surgery, valve opening and closing implants, 6 months after the measurement of wall thickness, lumen size and pathological changes. Results: After the autologous aortic valve was closed, the systolic blood pressure was increased. The diastolic pressure at the proximal end of the valved canal was significantly lower than that before autologous aortic valve regurgitation. The pulse pressure difference of autologous aortic valve was significantly increased. Diastolic pressure gradient on both sides of the aortic valve of porcine aortic valve increased. Magnetic resonance imaging at 2 months after surgery showed good valvuloplasty in the implanted valve, and B-ultrasonography revealed moderate-severe aortic regurgitation. 6 months after the operation of the septal flap septum, there was no change in the valved septum, thrombosis, valvular adhesions, thickened, stenosis and incomplete closure. There was no significant change in the septal thickness and lumen size of the septum with the flap, But the wall is obviously stiff, there are limitations of calcification. Ultrastructural and pathological examination showed that the inner surface of the valve and the tube have been endothelialized, interstitial cells exist in the leaflets and the duct, scattered in a little inflammatory cell infiltration. CONCLUSION: The aortic valve of aorta of aorta is implanted into the descending aorta of the thoracic aorta under off-pump, and the tissue engineering heart valve is established by closed aortic valve pruning The study of animal models has the advantages of small trauma, high postoperative survival rate, less interference to the experiment and less labor, material and financial resources.