Worley S J, King R M, Edwards W D, Holmes D R
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
J Am Coll Cardiol. 1988 Aug;12(2):458-62. doi: 10.1016/0735-1097(88)90419-6.
Decalcification of stenotic aortic valves is limited by the difficulty in removing sufficient calcium to restore valve function without cusp perforation. The present study demonstrates that electrohydraulic shock waves generated by a hand-held lithotriptor fragmented the calcifications contained within the cusps of four necropsy specimens of stenotic aortic valves. The electrohydraulic shock waves appeared to create a cleavage plane between the valve tissue and the fragmented calcific deposits, allowing the fragmented calcified masses to be removed without cusp perforation. Five patients with severe aortic stenosis also underwent successful aortic valve decalcification augmented by electrohydraulic shock waves generated with the hand-held lithotriptor, without significant complication. The shock waves permitted removal, from the aortic valve, of calcium that had not been removed by mechanical means. These results indicate that the addition of electrohydraulic shock waves to mechanical aortic valve decalcification may facilitate successful decalcification in patients undergoing operative treatment for aortic stenosis and may allow patients to avoid the need for aortic valve replacement.
狭窄主动脉瓣的脱钙受到限制，原因在于难以去除足够的钙以恢复瓣膜功能而不造成瓣叶穿孔。本研究表明，手持式碎石机产生的电液压冲击波使四个狭窄主动脉瓣尸检标本瓣叶内的钙化碎裂。电液压冲击波似乎在瓣膜组织和碎裂的钙化沉积物之间形成了一个分裂平面，使得碎裂的钙化块得以在不造成瓣叶穿孔的情况下被移除。五名重度主动脉瓣狭窄患者也成功接受了由手持式碎石机产生的电液压冲击波增强的主动脉瓣脱钙治疗，且无明显并发症。冲击波能够从主动脉瓣中去除机械方法无法去除的钙。这些结果表明，在机械性主动脉瓣脱钙过程中添加电液压冲击波可能有助于接受主动脉瓣狭窄手术治疗的患者成功脱钙，并可能使患者无需进行主动脉瓣置换。
