阅读说明：本技术 一种室间隔消融中实时显示跨主动脉瓣压力的系统 (System for real-time display of trans-aortic valve pressure in room interval ablation ) 是由 王召军 于 2020-07-27 设计创作，主要内容包括：一种室间隔消融中实时显示跨主动脉瓣压力的系统,它涉及医学领域,本发明的目的是为了解决跨主动脉瓣压力测量中无法实现瓣上压力和瓣下压力数据同步显示,跨瓣压力的实时数据无法自动生成的问题。本发明创新性设计猪尾导管和压力导丝的同机接口,瓣上压力和瓣下压力(左室压力)数据同步显示,更精确方便。将应用于冠脉压力测压的压力导丝应用于心室测压,解决了猪尾导管不能同时显示测量瓣上和瓣下压力的困难点。本发明应用于室间隔消融领域。(The invention discloses a system for displaying trans-aortic valve pressure in real time in room interval ablation, relates to the field of medicine, and aims to solve the problems that synchronous display of supra-aortic valve pressure and infra-aortic valve pressure data cannot be realized in trans-aortic valve pressure measurement, and real-time data of trans-aortic valve pressure cannot be generated automatically. The invention innovatively designs the same-machine interface of the pigtail catheter and the pressure guide wire, synchronously displays the supravalvular pressure and the infravalvular pressure (left ventricular pressure) data, and is more accurate and convenient. The pressure guide wire applied to coronary pressure measurement is applied to ventricular pressure measurement, and the problem that the pigtail catheter cannot simultaneously display the pressure on a measurement valve and the pressure under the measurement valve is solved. The invention is applied to the field of ventricular septal ablation.)

1. A system for displaying trans-aortic valve pressure in real time in room interval ablation is characterized by comprising a pigtail catheter (1), a pressure guide wire (2) and a trans-aortic valve pressure monitor (3);

the pressure signal output ends of the pigtail catheter (1) and the pressure guide wire (2) are respectively connected with the signal input end of the trans-aortic valve pressure monitor (3); the pressure signal receiving end of the pigtail catheter (1) is positioned on the ventricular aortic valve; the signal receiving end of the pressure guide wire (2) is arranged at the apex of the left ventricle;

the system for displaying the trans-aortic valve pressure in real time enables the pressure of the pigtail catheter to be consistent with the initial pressure of the pressure guide wire in the ventricle through in-vitro zero calibration, and synchronously collects pressure data of the pigtail catheter and the pressure data of the pressure guide wire in the left ventricle; the trans-aortic valve pressure is then obtained as follows, including the ventricular diastolic trans-aortic valve pressure, the ventricular systolic trans-aortic valve pressure, and the mean trans-aortic valve pressure:

ventricular diastolic trans-aortic valve pressure (left ventricular diastolic pressure-aortic supra-diastolic pressure);

the trans-aortic valve pressure in the ventricular systole is left ventricular systolic pressure-aortic valve upper systolic pressure;

mean trans-aortic valve pressure-mean trans-aortic valve pressure on the aortic valve;

the pressure data of the pigtail catheter consists of the diastolic pressure on the aortic valve, the systolic pressure on the aortic valve and the mean arterial pressure on the aortic valve; the pressure data of the left ventricular pressure guide wire consists of left ventricular diastolic pressure, left ventricular systolic pressure and left ventricular mean systolic pressure.

2. The system for real-time display of trans-aortic valve pressure in room-interval ablation according to claim 1, wherein when the trans-aortic valve pressure in ventricular systole is less than or equal to 30mmHg or the trans-aortic valve pressure value in ventricular systole is reduced by 50% or more than the initial value, the color of the digital font of the pressure monitor is displayed as green, and the digital font is flashed to display the character of 'up to standard'; when the ventricular systolic trans-aortic valve pressure is greater than 30mmHg or the ventricular systolic trans-aortic valve pressure value is not more than 50% lower than the initial value, the color is displayed as red, and the word of 'up to standard' is not displayed.

3. The system of claim 2, wherein the trans-aortic valve pressure is less than or equal to 30mmHg or the trans-aortic valve pressure during ventricular systole is reduced by 50% from the initial value.

4. The system for real-time display of trans-aortic valve pressure in room-interval ablation according to claim 1, wherein the trans-aortic valve pressure monitor displays a pressure time variation curve in real time, and the pressure time variation curve is divided into three parts: the first part is the aortic valve pressure curve, the second part is the ventricular pressure curve, and the third part is the trans-aortic valve pressure curve.

5. The system for real-time trans-aortic valve pressure display in room-interval ablation as claimed in claim 1, wherein the pressure monitor (3) is a trans-aortic valve pressure monitor.

Technical Field

The invention relates to the field of medicine, in particular to a system for displaying trans-aortic valve pressure in real time in room interval ablation.

Background

The main pathological feature of Hypertrophic Obstructive Cardiomyopathy (HOCM) is that ventricular septal thickening causes stenosis of Left Ventricular Outflow Tract (LVOT), which further causes significant increase of pressure step of left ventricular outflow tract, and can cause symptoms of chest pain, chest distress, syncope, dyspnea, and the like. Studies have shown that the more severe the LVOT obstruction, the more pronounced the clinical symptoms and the poorer the prognosis. Hypertrophic cardiomyopathy can originate from any age and is one of the leading causes of sudden cardiac death and heart failure in young people. The incidence of hypertrophic cardiomyopathy in adults in China is two thousandth, about 260 thousands of patients exist, and the treatment of hypertrophic cardiomyopathy is always a difficult problem in the cardiovascular field. The existing treatment scheme comprises a surgical excision method, an alcohol ablation method, a right ventricular pacing method, a transapical puncture ventricular interval ablation method (Liwen method) and the like, but the existing treatment scheme has the defects of large surgical injury, high risk, poor effect, incapability of accurately avoiding normal conduction bundles in advance, immature technology and the like and cannot be widely developed.

The use of compartmental ablation to alleviate LVOT obstruction is the primary treatment modality for drug treatment of patients with ineffective HOCM. Currently, ventricular septal volume reduction procedures mainly include surgical septal cardiomyopathy and alcohol ventricular chemical ablation. However, both of these solutions have the disadvantages of great damage and many complications. Right ventricular pacing is poorly effective and has been rarely used clinically. The Liwen method in China enables the device to be subjected to minimally invasive diagnosis and treatment in cardiac apex ventricular septal myocardium under the guidance of ultrasound, and good clinical effects are achieved.

The treatment principle of the Liwen RF system is that ions in the hypertrophic myocardial tissue cells are caused to generate thermal effect through high-frequency electric waves, so that the hypertrophic myocardial cells are caused to be dehydrated and necrotized, and meanwhile, the Liwen RF system can achieve the effect of blocking blood supply of the hypertrophic myocardial tissue. However, the scheme is extremely dependent on the guidance of the sonographer, has high requirements on the technical level of the sonographer, limits the popularization of the technology, cannot accurately avoid normal conduction bundles in advance, and needs temporary pacing for standby. Various defects of the above scheme limit the clinical popularization and application of the hypertrophic obstructive cardiomyopathy treatment technology.

By taking advantage of the advantages of small injury, small risk, mature technology and the like of the exploratory percutaneous intervention aortic retrograde endocardium radio frequency ablation room spacing method appearing in the technology, the method is approved by electrophysiologists in recent years, and a better effect is achieved. However, the method measures the trans-aortic valve pressure value by the traditional method, namely the reduction condition of the trans-aortic valve pressure is verified after the interval of the empirical ablation chamber, and great uncertainty exists in excessive ablation or insufficient ablation.

The percutaneous intervention aorta retrograde endocardium radio frequency ablation room interval method obtains the trans-aortic valve pressure value through the traditional method, can not monitor the reduction condition of the trans-aortic valve pressure in real time, and seriously influences the popularization and safety of the technology.

The traditional method for obtaining the trans-aortic valve pressure value comprises the steps of firstly measuring the pressure on an aortic valve by using a pigtail catheter, then placing the pigtail catheter into a left ventricle for measuring the pressure again, and manually calculating to obtain the trans-aortic valve pressure, wherein errors exist because the trans-aortic valve pressure is not measured simultaneously. The system can monitor the trans-aortic valve pressure in real time, can improve the obstruction related clinical symptoms of the hypertrophic obstructive cardiomyopathy patient for a long time by ablating the hypertrophic ventricular septum, does not need to open the chest, only needs minimally invasive interventional therapy, has small damage, can be moved on the ground the next day, has short hospitalization time and good effect, can restore most of the living and working capacities of the patient, can be safely and widely applied to the hypertrophic obstructive cardiomyopathy patient, monitors the trans-aortic valve pressure in real time, determines the ablation effect in real time, avoids the complications caused by excessive ablation of the ventricular septum, and also avoids the poor treatment effect caused by insufficient ablation.

Disclosure of Invention

The invention aims to solve the problems that synchronous display of the pressure data on the valve and the pressure data under the valve cannot be realized in the measurement of the trans-aortic valve pressure, and the real-time data of the trans-valve pressure cannot be automatically generated.

The invention discloses a system for displaying trans-aortic valve pressure in real time in room interval ablation, which comprises a pigtail catheter, a pressure guide wire and a trans-aortic valve pressure monitor;

the pressure signal output ends of the pigtail catheter and the pressure guide wire are respectively connected with the signal input end of the trans-aortic valve pressure monitor; the pressure signal receiving end of the pigtail catheter is positioned on the ventricular aortic valve; the signal receiving end of the pressure guide wire is arranged at the left ventricle apex;

the system for displaying the trans-aortic valve pressure in real time enables the pressure of the pigtail catheter to be consistent with the initial pressure of the pressure guide wire in the ventricle through in-vitro zero calibration, and synchronously collects pressure data of the pigtail catheter and pressure data of the pressure guide wire in the left ventricle; the trans-aortic valve pressure is then obtained as follows, including the ventricular diastolic trans-aortic valve pressure, the ventricular systolic trans-aortic valve pressure, and the mean trans-aortic valve pressure:

ventricular diastolic trans-aortic valve pressure (left ventricular diastolic pressure-aortic supra-diastolic pressure);

the trans-aortic valve pressure in the ventricular systole is left ventricular systolic pressure-aortic valve upper systolic pressure;

mean trans-aortic valve pressure-mean trans-aortic valve pressure on the aortic valve;

the pressure data of the pigtail catheter consists of the diastolic pressure on the aortic valve, the systolic pressure on the aortic valve and the mean arterial pressure on the aortic valve; the pressure data of the left ventricular pressure guide wire consists of left ventricular diastolic pressure, left ventricular systolic pressure and left ventricular mean systolic pressure.

Further, when the aortic valve crossing pressure in the ventricular systole is less than or equal to 30mmHg or the aortic valve crossing pressure value in the ventricular systole is reduced by 50% or more than the initial value, the color of the digital font of the pressure monitor is displayed as green, and the digital font flickers to display the character of 'up to standard'; when the ventricular systolic trans-aortic valve pressure is greater than 30mmHg or the ventricular systolic trans-aortic valve pressure value is not more than 50% lower than the initial value, the color is displayed as red, and the word of 'up to standard' is not displayed.

Further, the trans-aortic valve pressure is less than or equal to 30mmHg or the trans-aortic valve pressure value in ventricular systole is reduced by 50% compared with the initial value, on the basis of reaching the initial value.

Further, a pressure time change curve is displayed on the trans-aortic valve pressure monitor in real time, and the pressure time change curve is divided into three parts: the first part is the aortic valve pressure curve, the second part is the ventricular pressure curve, and the third part is the trans-aortic valve pressure curve.

Further, the pressure monitor is a monitor of the trans-aortic valve pressure.

The invention innovatively designs the same-machine interface of the pigtail catheter and the pressure guide wire, synchronously displays the supravalvular pressure and the infravalvular pressure (left ventricular pressure) data, and is more accurate and convenient. The pressure guide wire applied to coronary pressure measurement is applied to ventricular pressure measurement, so that the problem that the pigtail catheter cannot simultaneously display the pressure on a measured valve and the pressure under the valve is solved; the pressure guide wire is arranged at the apex of the left ventricle, so that the pressure difference between the apex of the left ventricle and the aortic valve can be displayed more accurately. The system of the invention can record all data in the background in real time by displaying the systolic pressure, the diastolic pressure and the average pressure on and under the valve in real time, and can call the background data in the later period to check the data dividing condition of each time point.

The novel technology for guiding the radiofrequency ablation of hypertrophic obstructive cardiomyopathy by the real-time trans-aortic valve pressure display lower ventricular interval modeling method has not been reported. The invention utilizes the existing mature cardiac catheter minimally invasive radio frequency ablation technology, combines a three-dimensional mapping modeling technology, a real-time aortic pressure monitoring technology and the like to form a set of complete operation scheme and skill. The technology is complex in operation, accurate in modeling, high in operation difficulty of a bundle branch mapping technology and the like, but for a mature operator of cardiac electrophysiology, the technology is mature and reliable and can be mastered through simple training. The method is safe and reliable, the ST pressure monitoring catheter ensures the reliable attachment of the left and right chambers during modeling, the pressure at the head end of the catheter can be monitored in real time, and the risk of heart perforation is avoided to the maximum extent. The mapping ablation catheter maps the left bundle branch, the left front branch and the left rear branch in the left ventricle in advance, can monitor in real time during ablation, and avoids the damage of a normal conduction bundle as much as possible. The real-time trans-aortic valve pressure monitoring system can evaluate the ablation effect in real time, and avoid excessive ablation or insufficient ablation.

Drawings

FIG. 1 is a schematic diagram of the system of the present invention;

FIG. 2 is a view of a location of a fat interval target point under ultrasonic guidance;

FIG. 3 is an ablation map after positioning of the fat spacer target;

FIG. 4 is a graph of pre-ablation heart color ultrasound assessment trans-aortic valve pressure;

fig. 5 is a graph of post-ablation cardiac color ultrasound assessment trans-aortic valve pressure.

Detailed Description

It will be understood by those of ordinary skill in the art that the foregoing embodiments are specific examples for carrying out the invention, and that various changes in form and details may be made therein without departing from the spirit and scope of the invention in practice.

To make the objects, aspects and advantages of the embodiments of the present invention more apparent, the following detailed description clearly illustrates the spirit of the disclosure, and any person skilled in the art, after understanding the embodiments of the disclosure, may make changes and modifications to the technology taught by the disclosure without departing from the spirit and scope of the disclosure.

The exemplary embodiments and descriptions of the present invention are provided to explain the present invention and not to limit the present invention.